Posting on the off chance it helps someone else because I know I was doom scrolling looking for experience with an HSG.
First of all, hi, this whole process is tough and scary and I feel very vulnerable as I’m sure you do too and I’m proud of you for even considering this stuff.
My husband and I met with our RE for the first time about 3 weeks ago and we’re going through the whole diagnostic battery: SA, carrier and infectious disease screenings, HSG, and SHG (saline sonogram). Today was the HSG and here’s the play by play:
Got to the office, led back to the testing room, was told to pee in a cup for the pregnancy test and then undress from the waist down.
Laid on the table, back of my knees in what felt like saddles rather than stirrups but you get the point, hang out with zero modesty while they raised the table to the right height for the x-ray (it’s really more like a CT scanner without the gigantic donut), PA came in and explained what they’d be doing.
Speculum went in, as much as fun as I usually have with that for my Pap smears Used a cotton swab to scrub betadyne on my cervix (in my opinion this was the most uncomfortable part) Inserted the catheter (really didn’t feel it) Inflated the balloon (small cramp but nothing too bad) Inserted the dye and it was over in about 5 minutes
I had a fallopian tube that was “hiding” behind my uterus so they adjusted the x ray to get a better view and then it was all over.
Most awkward part was grabbing the pad they put under me like a makeshift diaper and waddling back to the restroom to pee and get dressed after. Wearing a pad and period undies for the rest of the day in case of any spotting and such but no other cramping or anything else. I also took 800 mg of ibuprofen 1 hour before and antibiotics started the day before.
To those of you going through an HSG, your results may vary but I wanted to share my experience in case it’s helpful

I didn’t know what flair to use. I’m technically visiting for a few weeks (used to live here) so that’s what I chose. I’m not sure if this is appropriate to post here, but I drove myself crazy searching for anything I could find on what to expect going into PP. I was scared, anxious, and felt thoroughly alone. Though I’ve always been very pro-choice, this isn’t something I ever imagined I would have to do. What I was looking for - and couldn’t find - was a step by step breakdown of everything that happens. I’ll go into as much detail as I can remember.
I was able to schedule an appointment a week out. Unsure how far along I was, I scheduled a surgical (in-clinic) procedure as opposed to the medication (2 pills over 2 days at home). The day of, I showed up, checked in, and was taken back for a urine sample about 20 minutes later. Waited for about 10-15 minutes after that and was called back for my ultrasound. Since she was able to see what she needed via the abdominal ultrasound, there was no need for a transvaginal one. I was 5 weeks 1 day. Directly afterward, I was taken to speak to the education counselor who explained the procedure and informed me of the different options for pain relief/sedation as well as aftercare. At this point I asked if I could switch to medication abortion since I was much earlier than I thought and she said absolutely. After discussing the pros and cons of each in more detail, I decided to proceed with the surgical. From there I was taken straight to the recovery room where I was given another opportunity to ask any questions. This is where I took my medication for sedation. I chose mild sedation which meant that instead of an IV drip, I was given an antibiotic, Valium, oxycodone, and ibuprofen. I waited 30 minutes for the medication to start working and then was taken back to the exam room. We started right away. They numbed my cervix which I could feel but wasn’t too painful really. The most pain I felt during the entire procedure was akin to mild cramping. It was over in 5 minutes. I was then taken back to the recovery room where they monitored my vitals for about 15 minutes and then went over discharge info. I was in the clinic from 9:10am until 11:30am. The staff was mostly very neutral-toned and straight faced. Not overly friendly but not rude or judgmental. I never felt rushed and they continually asked how I was doing and if I had any questions or concerns. The procedure cost $500. They did ask my income, I’m assuming to gauge whether they could offer me assistance.
There was one protestor when I entered first thing in the morning. I had sunglasses and earbuds in so I’m not sure if he said anything to me. There were a few more as I left but by then they had security/escorts out front.
Edit: Thank you everyone for your kind words. I wasn’t sure how this post would be received, so I had mentally prepared myself for the worst. I did want to add a few things that I forgot.
I chose mild sedation over IV so that I wouldn’t have to stay in the recovery room as long afterward. The IV meds I believe would have been the same or similar, but they would have worked immediately and I could have asked for more if needed. The clinic did not offer general anesthesia. I’m glad I chose mild. It was more than enough for me and the drowsy effects wore off in about 3 hours.
Someone asked why I chose to go ahead with surgical rather than switch to medication. Medication abortion is 2 pills taken over 2 days. The process is longer, more private, and feels more natural like a spontaneous miscarriage. The privacy was appealing, but I have experienced miscarrying a previous wanted pregnancy and that’s not something I wanted to go through again if another option was available. Also, surgical/in-clinic abortion gave me the most peace of mind that my uterus was emptied completely.
I barely bled and had no cramping until about 48 hours later. Then, I experienced what felt like a normal period. Mild to moderate cramping and lower back pain and a pretty regular flow for a few days. I did pass a few very small clots.

We all know our our Prophet Dada, but some are sceptical of him. I found another guy who wrote a very informative “guide” and his success story with IMO.
He actually met with Pimentel and asked him a lot of questions. The whole article explains everything about SIBO, which most of us already know if you’re not new; prucalopride; his story; but the interesting part is the questions to Pimentel.
Here are the most important points:
SIBO is basically a condition that is,** in almost all cases, caused by poor gut motility** (failure of the MMC to clean out your small intestine between meals). You cannot get SIBO unless you have a motility problem (except in my case where I had SIBO but my motility was normal showing there are exceptions to every rule). Therefore, in almost all cases, “curing SIBO” is only curing the symptom, not the disease.
If you don’t want it to reoccur, you must find out and fix the root cause of the motility problem. Finding out the root cause means a series of tests which may or may not include physical exam (especially listening to your stomach, upper endoscopy (with biopsies), intestinal MRI and CT scan, smartPill, IB smart blood test, etc). The list of disease states leading to SIBO are listed in Table 1 of Mark’s paper referenced below. So if you aren’t following a logical process to find the root cause, it’s going to keep happening and you’ll be stuck on taking a prokinetic each night for a long long time. Finding the root cause is most often a process of hypothesis and eliminating possible causes.
The 2 “golden rules” in order to get rid of SIBO and minimize recurrence are: 1) take a prokinetic pill and 2) eat discrete meals (for example at 8am, 1pm, and 6pm; ideally at least 4 hours between meals, and you do not want to eat right before bedtime).
You can** “kill your way” out of SIBO with antibiotics, but that is only recommended at the very start to get to remission faster. Fix your motility is key. It’s way easier to flush the stuff out with a prokinetic than to kill it.**
In most all cases, until you discover the underlying cause, the only thing you really need is a prokinetic. Mark’s favorite for the prokinetic is prucalopride taken at a low dose (typically .5mg each night before bedtime on an empty stomach, but for some can be less or more). For prucalopride, eat nothing for at least 4 hours before taking the pill at bedtime. Then, after taking the pill, try to fast as long as you can before eating something. The longer you fast, the greater the benefit. But don’t try to be a hero. There is no award for fasting for all 12 hours and nobody is going to test you and see how you are doing. The drug wears off in 12 hours so no point in fasting longer. Personally, i just eat when I wake up and don’t optimize the fasting period.
If you cannot tolerate prucalopride, there are other drug options (mentioned in Table 1 in Mark’s paper below): erythromycin and domperidone.
Using only these the two golden rules in #2 above, most people should be able to completely get rid of SIBO and keep it from recurring; one drug and one eating pattern. Total drug cost (if not covered by insurance): typically a little more than $1/day (if you are clever and buy the 2mg pill and split it into 4 pieces like I do).
Most people don’t know the 2 golden rules, so they relapse, sometimes quickly. I hear stories of people taking multiple rounds of antibiotics then herbs in between the antibiotics. This is insane. You really only should have one round of antibiotics tops, and then the pro-kinetic.
Mark’s** Low-Fermentation Diet** (LFD) guide is highly useful for understanding SIBO and how the digestive system works. It’s a short read, and full of great info and insights you won’t find anywhere else. Mark’s LFD is much easier to adhere to than any of the other SIBO diets (like SCD and FODMAP diets) because it allows a more options so you don’t feel deprived. The whole point of the diet is to identify foods that can be more fully digested and thus minimize bacterial growth. Some foods may not agree with you; avoid them. Some foods may be inappropriate for you, e.g., white bread and rice if you are a diabetic. The foods are simply a list of “relatively safe” foods in general. And you can cheat since the golden rules are the main drivers, not diet. The diet minimizes food for the bacteria if you have not yet addressed the underlying cause of your SIBO. Something is wrong to have caused you to get SIBO in the first place. The LFD is just meant as a stopgap until you discover the root cause of your SIBO. If the root cause is incurable, the the motility is key and the LFD becomes more important. However, if you can** restore normal motility overnight through a prokinetic, the LFD is irrelevant since you are fully cleaned out every night.** I did the LFD for awhile, but I now eat normally. Absolutely no change in symptoms. So be practical: try the LFD diet and if there are no changes in your symptoms, you have Mark’s permission to give it up.
While you are on the antibiotic regimen, you should ignore the diet. The bacteria are more easily killed when they are replicating so you want to feed them. Mark says, “I have told my patients from day one of rifaximin or treating with antibiotics — and this goes back to the 1980s; this is an old microbiological concept — happy bacteria, happy and well-fed bacteria, are more sensitive to antibiotics and are easier to kill. What that means is that most antibiotics work on the replicating cell wall of bacteria. When bacteria are in hibernation, starving, distressed, they wall off, don’t replicate, and they just sit there, waiting for conditions to improve. That’s a survival mode. So when the bacteria are in survival mode, antibiotics won’t penetrate and won’t work as well.”
While you should be able to get rid of SIBO with ONLY a good prokinetic, you may be able to get rid of SIBO faster by starting with a 2 week antibiotic regimen. For methane dominant SIBO, the recommended treatment is 550 Rifaximin ( Xifaxan)+ 250mg Metronidazole (Flagyl) taken 3 times a day for at least 14 days. This is slightly better than the combo with neomycin. Some people get stressed out about not tolerating the drugs. No problem. The antibiotics are optional.
A lot of people may make the mistake of upping the dosage of prucalopride which may lead to undesirable side effects. Also, note that Prucalopride will induce phase III MMCs only when taken in a fasted state. The whole point of prucalopride is give your intestines an extra “boost” during the longest fast of the day (overnight); therefore for SIBO it is prescribed at 25% of the “standard dosage” because the “standard dosing” for prucalopride is set by the labelled use (chronic idiopathic constipation (CIC)), not for SIBO patients. Personally, I found nearly zero difference in how I feel at .5 mg to 2 mg. So stick with the .5 mg unless you have a good reason to go higher. Always take fasted (>4 hours since last meal), right before bed. In my case, if I eat at 7pm, I’ll take the pill at bedtime. Otherwise, if I wake up at night, I’ll take the pill. The pill lasts for 12 hours so ideally you should not eat anything (including pills/medication!!) for 12 hours after taking the pill to get the fastest improvement and the most bang for your buck. If you can’t last 12 hours, don’t sweat it. I’m just citing the ideal. There is no benefit to fasting longer than 12 hours after taking the pill. So far, no side effects whatsoever doing it this way.
You can NEVER win the war against bacteria by trying to starve it. Bacteria multiply by 2 every 12 hours. So if you could wipe out 99.9% of bacteria with an antibiotic, it will all return in just 5 days. So if you starve the bacteria, the stuff that grows back will be all replicas of the bacteria that is immune to starvation. This is evolution at its finest (especially so if you have methane SIBO; methanogens are very primitive and very hard to kill). This is why all the clever, innovative approaches people have proposed (Iodine, chlorine, ozone, …) are simply never going to work. You won’t kill it all and it comes back way too fast. Your ONLY hope of winning is to sweep it out of the small intestine with mechanical action, like a broom sweeping out debris. This is what the Migrating Motor Complex (MMC) is all about. MMC refers to the “gut clearing” waves that happen every 45–180 minutes between meals. If the gut clearing is weak, you get trash left over in the gut, i.e., SIBO.
About half the time, elemental diets do work, but they only work because they partially restore MMC function! Per Pimentel: “I think the elemental diet is working because it is absorbed in the first 3 feet of small bowel. So the latter 12 feet of small bowel do not see food and bacteria die and dramatically reduce in number. You might say “but in the first 3 feet there is all that good elemental stuff”. That area is tough for bugs because they get bombarded with acid (kills them). They get bombarded with bile (it’s a detergent and kills them) and they get bombarded with enzymes that try to digest them, from the pancreas (which can kill them). Also, If 12/15 feet of small bowel no longer have bacteria (starved out), that’s an 80% reduction in bacterial load.” But there has to be more going on than this. As noted even the previous point, even if you killed 99.9% of the bacteria this way, it will all come back in just 5 days! So what’s going on? Mark wrote, “We did see in a 2003 paper we wrote that when you get rid of SIBO, MMC are halfway normal. Not perfect. So still could use prokinetic in order to stay in remission.” In short, when you eradicate the SIBO, your MMC comes back halfway which can keep you from a remission and this remission is even more likely if you take a prokinetic. That’s why the Elemental Diet works for some people… kill + partial restoration of MMC
Probiotics and prebiotics: Avoid both. Probiotics have mixed results and prebiotics (fiber) is something you want to avoid since it ferments. But like I said, this is fine tuning. I pretty much ignore this myself and there is no symptomatic difference.
—-> his findings go along Dada’s: fix MMC, nothing else matters. Don’t forget that you can have normal large bowel motility, but dysmotility in the small bowel - “going” regularly doesn’t mean your overall motility is okay.

I haven't had the time to take a look over any of the previous posts on this subreddit. Nor am I too familiar or experienced with Sinus infections. I've only once before ever had a sinus cold that was bad enough for me to reach out and seek medical treatment, which turned out to be sinusitis. Which was about 8 years ago now. I remember it being a horrible, mimicking allergies alot, watery eyes and stuffy in all the facial sinuses, took me about 2-3 weeks to fully recover with no antibiotics , and only took about 2-4 days off work.
But now, almost ten years later (now 33F). I have the WORST head cold I have ever experienced and I'm really doubting this could JUST be a sinus infection because I am in just so so much prolonged pain, and it's taking every fibre of my being just to exist at this point 😅.
The rundown. Almost two weeks ago (May 27th 2024). I finish up a half day at work, feeling completely fine. No allergy symptoms, energetic, feeling great. But I had plans for later that evening so I decide to have a nap in the afternoon. I only napped for about 2 hours, but the second I woke up, I was in shock. I had INSANE pressure and congestion in my face, localized only to the left side. Under my eye, beside my nose, above my eye brow, in my ear, and what felt like the entire center of my face. I could feel the pressure in the roof of my mouth it was that intense.
It was like I just woke up two hours later, somehow being days into a severe cold, and feeling like there was a balloon expanding inside my face, about to explode at any moment. Yet two hours earlier I was completely fine?
Anyways I got up, blew my nose and felt immediate relief. Yet the pain was still there. For the next few days the congestion was manageable, but the pain in my face was unreal. I could only explain it like it felt like having microshards of glass under and between my eyes. And I had the constant feeling like I was about to sneeze. But never did.
Over the next week it just progressively got worse. I started to get the feeling like I was drowning from my nose, similar to the burning feeling you get when you jump into a chlorinated pool and get a ton of water up your nose and start choking. I couldn't go 5 minutes without blowing my nose (extremely yellow and pussy everytime since the beginning) My teeth started aching, my ears even more. And of course a CONSTANT headache. Bending over became excruciating, the pressure on my eyes, nose and teeth was almost enough to make me fall over lol. It got hard to even keep my eyes open in light, watching tv, or being on my phone is exhausting. The taste from my sinuses tastes like poison. The smell in my nose is horrendous 🥲.
Then the extreme fatigues and fevers started kicking in, and I knew it was about time I see a doctor. She told me it was likely a bacterial sinus infection as I was getting progressively worse over a two week period, and the fact it started to suddenly.
Anyways, I'm on my second day of antibiotics and a nasal steroid. And I'm just still not feeling better at all. I know the antibiotics are well into my system because I'm having killer stomach pains. But I'm just feeling so defeated and losing hope that I'll ever feel relief, this amount of pain and suffering feels silly for just a sinus infection? I've already taken too much time off work, tomorrow will be my last day off then I have no choice but to work 10 hour shifts Fri-Sun.
I've truly never experienced anything this sufferable (and if I had the time or energy to explain some of my medical past and history and some of the things I've went through, some might find that rather shocking that this is the worst I've ever felt).
Is it just this bad compared to my last Sinus infections because it's bacterial and my last was viral? Do I need to be patient and just wait longer for the antibiotics? Did I get something in my nose somehow before I napped, that was trapped and turned into such a severe infection?
Sorry for all the rambles, I know it's long and likely all over the place. I'm just really dying 🥹🥹

• Also note, because of an already existing health problem, I'm not allowed to take any Advil or NSAIDs or essentially any allergy medication, or anything that isn't just simply tylenol 🙃. So I am aware that's likely why I have suffered this much. But at this point I'm just reaching a breaking point and need some feedback from others to either validate my pain, or to maybe add some insight on other possibilities or complications of Sinus problems that I may not know about.

Thanks to anyone who takes to time to read this.

I've had an amazing time being in the midst of the barely controlled chaos of what I can imagine is probably your average workplace experience because of the hilariously displays of incompetence I've had the pleasure of sharing with my friends and coworkers over the years. Have you ever been rendered speechless after brazen displays of decision making from "experienced" old-blood in the company you work for? Have you ever felt like a crazy person after trying to follow the logic of both your coworkers and specifically the actual people in charge at any given time? If so you would probably have built a comeraderie with the people you went through that with and had some hilarious tales to reminisce about along the way, and today I finally feel like the story of my first job would make a semi-entertaining enough of a tale to put it out there. I've more or less told this story in chunks throughout the years and I honestly just want the catharsis of having fully fleshed out the whole thing word-for-word. I want to throw in as much transparency as humanely possible here, and up front say that everything here is as accurate of a retelling of what I personally experienced as well as what I can infer went down around me during my time in this workplace and any opinions I have about any of the decisions made by other people during this time are my own. I won't be naming any people by name, nor do I want to try and slander people for things that most workplaces I would imagine partake in such as workplace hearsays about if someones sleeping with someone else or backstabbing up the ladder of success, etc. I'll try to keep the stories to my truthful, personal experiences rather than me spit balling what doesn't pertain to the actual workplace basically.\
I started working at the good ol TnT a year after dropping out of college (2016 for context and I think I was 19), which I'd only gone to for a year anyways because that's absolutely not how I personally want to be literally throwing away money I definitely didn't have regardless of the little scholarship or whatever it is that I had. I'm your standard introvertive nerdy type with at least an average to decent amount of social anxiety, so I was definitely nervous about getting out of the house and starting any form of careejob, and going into my first week I was even having to force myself to go get my license levels of "prepared" lol. My only experience going into this job was I'd played with Yu-Gi-Oh and Pokemon cards as a kid and been a gamer all my life, which it turns out is all you really need to be able to color sort pieces of cardboard. I started out in their lot making side company Golden Groundhog so my only responsibility was making specificcard quantity lots out of the large amounts of bulk they had on hand. The job was extremely easy for anyone who could both stand, read, and wanted to put even a small amount of effort into, so I quickly proved to the couple of team leady/manager types in the department that I could be trusted to count to 100 instead of color sorting pokemon bulk (hopefully going forward you start to see a trend of how easy these jobs actually are).\
Management in GG was pretty great tbh, they were professional and the mantra was simply you can chill and listen to your headphones/talk as long as you keep your hands moving, and any struggles that may have came from being on the floor in that company could only really occur if someone on a president of the company level would come down with complaints. Notoriously at this time the president of the companies was an extremely volatile individual that evvvvvvverybody would dread to see coming regardless of who he interacted with. Imagine someone who would have no qualms telling someone to their face they're stupid or at bare minimum making them feel that way, making decisions that involved making people work overtime as an expectation, and generally making people feel like peons. That was the atmosphere around certain people in higher forms of management going forward throughout the different eras of Troll as this status quo was more or less just taught to be blatantly honest. For instance, there's many stories I've heard over the years of blatant toxic masculine misconduct that abbbbbbbsolutely I can see happening in my opinion, which matters in the context of my experience there because some of the people still in charge at this time lived through those frat party eras of the company.\
My introduction to the main working operations of Trolls main business came in the form of new product releases, as the side company I'd started in would regularly be brought over to Troll's A-list department (an entire department that busts any sealed product down to singles that are then sorted and keyed onto the website to sell) because new releases were theeeeeee most important things to the company at the time. We're talking like 20 people all around a huge table busting booster boxes or tins of new card sets. It was always in and of itself a pretty great although high responsibility time and really highlights that this job/industry can be an amazingly enjoyable career. At the time with my little experience I wouldn't have any of the gravity or actual personal responsibility though because I was a minimum wage grunt just busting packs, but for context I wasn't having to count or key any of the product onto the website, which in and of itself is still easy, but at this time I was just a min wage fellow who got to go home at a reasonable time, but would before too long be something I was intimately familiar with doing.\
After about half a year or so I more or less got transferred but also promoted into Troll as the Keyer for A list, which I would cement my running trend of over preforming in the given role enough to be "rewarded" with endlessly increasing responsibilities. I went from being a Keyer to being: team lead of the keying department, processing employee of the year one year, then the only Keyer, helping stream line our verifying of keyed orders for a joint keying/verifying department for trolls internal data entry, being solely over making sure every new release was keyed on time or close enough (spoilers that's overtime every other week for every new release we've done for years), being primarily responsible for processing every important show buy and all of our show products coming back from every convention troll participated in for years, being brought in to work on site during covid because that was a mishandled shit-show, after work from home ended I became an assistant manager for processing for a newly formed second shift, then the only processing employee on our second shift because management literally kicked everyone else out (I can't wait to get to that detail lmao), to then taking over processing all of trolls sealed product including still keying all of the new releases, making sure new release products went live to sell at midnight, earning proccessor of the year again, and by this time I can wind down with my accomplishments because mismanagment of thr company began to finally wittle away at my ability to even participate in the dwindling work still left. Regardless, I can at least say from this rambling that I should be trusted to know what I'm talking about here lol, so let me wind back to explain any of the noteworthy points of drama over those 6 or so years I skipped.\
We transitioned processing managers many times over that period. All together I thinnnnnk I've worked with 7 or 8 different managers give or take a couple, some of which were amazing to work with and others absolutely had literally no experience doing our jobs and were only made managers because in the absence of someone actually being in charge of the company as a whole it always came down to "oh this person is populais my friend/idgaf this person will probably make it work who cares", which I'm honestly giving too much credit to the thought processes even with that logic. Whoever was in the management position was always either good at the people aspect and competent at the job or competent at the people and good at the job, or were just completely a waste of space and time and was a figurehead for a president of the company who only cared that they had a special parking space with their title in the parking lot. Regardless, back to points of drama.\
In 2 instances of working there we dealt with week long power outages because of how old and in ill repair the warehouse we worked in was. 1 instance a property employee for the building stuck what I assume was a battery tester up to our big industrial electric generator thingy (big source of electric for the building I dunno what you'd actually call it) and blew himself unconscious onto the ground. I assume he's okay still, I don't personally know, but regardless we were out of power in the entire warehouse that we shared with multiple companies for weeeeeeeks. We worked with headlamps during the summer with no fans and no computers for the most part alllll while working on either a gencon show or one of the other huge shows of the year. My mind blanks atm on what the other big show is tbh. Regardless, it's in situations like this that the fractures in competence and decision making from the higher ups really shows because the general attitude from said people usually could be summed up as "we want you to do a weeks worth of work in 3 days with no computers, have 6 people who dont know how to do your job do parts of your job incorrectly because of course that will save time, be constantly up your ass because now we have to be because some head honcho is up my ass (I'm mr meeseeks look at me)" It's here that I need to comment that not everyone I worked with over the years was qualified to do the jobs that the main requirement was being able to read and write because sooooooo many people over the years would absolutely drag our entire departments down. Some people will never be compatible with certain jobs and just making efficient basic decisions, and it would have helped over the years of our at-will company in our at-will state would have at-will fired problem people at any point, but for real people would only get fired in that company of they personally made a higher up slightly inconvenienced. If someone was holding up our entire buylist department it would take them cutting off someone in an iced over parking lot to be fired on the spot. Also, on top of allllllll of this was the constant need to justify to a president of the company why someone who was worth even a slight raise was potentially worth more than a $0.50 raise (in hindsight everyone should have just accepted that card companies should pay less in wages because the company as of the time of writing is doing another massive wave of layoffs because of how high our wages had become).\
It's sad to say that those times were my most enjoyed on the job/day to day times at Troll simply because the work was fulfilling. It was challenging for me to get everything I wanted to accomplish done on time, and my work ethic was up to par for the challenge back then. I thrive off of having to put in the hustle and I believed we were kicking ass back then because the card buys were always hot and the industry was doing pretty well imo. My main team member over verifying and I pushed out an ungodly amount of work to be blatantly honest. Towards the end of this golden era for me was pretty close to before covid hit the world, and some massive changes to the job as well as rotating presidents, managers, owners of the freaking company, and various other shenanigans would irreversibly affect the entire company in crazy ways.\
I'll go ahead and start with Trolls Evo program during this time. Leading up to covid for about 2 years or so prior our evo departments were a start up program by higher ups in Troll that was a money making method similar to other big name card marketplaces. It gave Troll the option to have sellers send their own products to our warehouse to be processed and listed to sell in their name and they would pay a processing fee and Troll would get a small portion of the sale as compensation. I to this day don't know how Troll was ever compensated for processing fees however. I personally don't understand how our website and employees could ever have been able to correctly make sure that all of the full 5-ks of basically bulk our "customers" would send in could possibly have been profitable for the Evo merchant to pay us for the hours it would probably take to properly sort and enter in the varying value of cards therein, but I couldn't have possibly known at the time as the Evo department and trolls processing department were completely separate. That would change however as literally at the exact same time the bright idea in the company was for Evo to be combined in with processing, troll to have a new president of the company put in place with drastic changes to how the warehouse layout would work, to not inform IT that our entire order printing for put away/pulling to be printed because alllllllllllllll of our product would then be printed out of alphabetical order as well as combining multiple games in that sort (I'll explain shortly it's ridiculous), we were moving our entire card warehouse inventory over halfway across our massive warehouse because our parent company was both trying to sell Troll annnnnd because they wanted the newly-fixed-roof area for their own shipping company (btw our warehouse leaked like a mofo and that's pretty not smart to be storing easily damaged expensive cards in), and were about to be rotating out processings managers. Does that sound like a cluster fuck to you? Because it really really was one.\
Let me start with Evo being combined with processing. Literally nobody was ready for that even though it was in plans for maybe weeks? None of the higher ups had a plan, none of either sides management had a plan, it was all literally done by the seat of the employees pants. Like how was the responsibility of the months behind Evo orders going to be split up? How does the Evo website programs work for all of us that had literally never used it? How was our barely 2 man sorting team going to be expected to help? Also, from my perspective, how was I as head of data entry for processing going to help? I'd never used the program so I would def have loved to have been introduced to it prior, but how was I going to have the time when my responsibilities were already stretched to all shows, new releases, all official acquisitions, all returns, all generic random BS that needed keyed? Now there's an entire company worth of merchant orders that it turns out had been beyonnnnnnnnnd behind that needed more than just keyed. They needed sorted. They needed graded. They needed keyed.\
Thennnn depending on who keyed it you would need to meticulously go through and make sure said person didn't waste everyone's time by keying cards incorrectly, not grading them correctly, not sorting them correctly, and the list keeps on going dude. Oh, and i mentioned we rotated managers during this time? So not only was there no plan from management, we didn't fucking have management because during the move our slave drivers of higher ups were openly rude to our female manager of processing and basically bullied her into quitting. It's once again an example of the higher-higher ups will only get involved when they want to look good, and part of looking good is to crack that whip on people who were absolutely doing a good job despite moving an entire warehouse in 2 days in the 80+ degree warehouse. Oh, I forgot to mention, we apparently had weeks worth of time to move buttttttt our president of the company decided it had to be done on Saturday and Sunday, which was mandatory to work or you get fired, annnnnd we were expected back at work Monday for regular schedules. They for some god forsaken reason believed it was a good idea to crack a metaphorical whip during all of that.\
You know how I mentioned the print offs thing earlier? Well the move involved a new layout of the shelves that held all our cards. Instead of there being a Block for each game where each bin location was "letter of the block for each game" - "number of shelf then set code for the box" the first letter of the Bin would denote which row the shelf was in. Innocent enough, so each first letter was a row that's simple enough. But each row would include EVERY BLOCK OF CARD GAME, THEREFORE EACH BIN LOCATION WOULD GO ALPHABETICALLY "MTG, POKEMON, YU-GI-OH, ETC" THEN WOULD REPEAT GOING THROUGH EACH GAME ON THE PAPERWORK MULTIPLE MULTIPLE TIMES AGAIN AND AGAIN AND AGAIN. Now for warehouses that deal with large boxes of let's say cereal or car parts or anything not small cards in big boxes that may not be that bad of a pulling/put away system, and hell even for sorting even though there's smarter ways to do that for sure. But for fucking cards with alphabetical codes that you have to be able to identify and pull, key, sort, put away in an efficient manner you would at bare minimum love for your important paperwork to coincide with how you've done your job for a living for 5 or so years at the time right? Literally 4 of us the week before talked with our inventory department and we all realized how fucked it was going to be. Our leadership in the company, did, not, care, at, all. The excuses we were given? Oh, UPS or FedEx or whoever gave us this layout idea and they're paying us money to use it so it's a good idea. Oh, we're planning on going paperless so who cares if the print offs don't show correctly. Oh, we're literally getting rid of all verifying because fuck it who cares about all of our incompetent workforce that can't key a card correctly it doesn't matter if we buy cards wrong through buylist or have sooooooo much wrong inventory, I'm sure insurance will cover any losses etc etc. I poured sooooooo much into getting my processing speed as high as I possibly could all for these incompetent jackasses to just decide they knew better than the last person in charge.\
Oh, and alongside allllllll of that our next 2 or 3 processing managers had no idea what they were getting into. They were not at all prepared to get any of our responsibilities down to a competent level, and they actively threw away all of the notes literally given to them by previous management because "nah they got this." Then on top of that they were completely not ready for an entire newly made 2nd shift to also be working in the same areas. I'm talking for the first few weeks computers weren't setup for our buylist department, our IT department legitimately didn't setup any 2nd shift processing employee with access to their own Windows login on a computer with the keying software permissions. I legit had to login to every one of my people's computers under my team lead/assistant manager permissions just for people to actually be allowed to work. And the entire time when I would come in and start trying my hand at this entire Evo trash fire of a priority or organization or work method or anything involved with getting things worked on efficiently? People newly over Evo started throwing their egos around about who's team lead and who says how things should be done, any amount of pallet organizing I would do would be undone the next morning, literally nobody would have an opinion on what we should work on until AFTER we started working on things I'm a way that I tried to make sense of. Legitimately this system on the computer alone made no sense. A merchant would send us fulllllll boxes of cards and it would be on 1 single shipment. So we were expected to get through full boxes allllll on 1 order, which would absolutely bog down our computers, printers, what our employees would be working on for a day, our throughput for getting more cards on the shelves, legitimately every aspect of the job. At the same time, 2nd processing was made of a couple veterans, a couple very competent people I legit got hired in as personal friends and step brother, and like 2 really good people that got hired in around that time. Other than that I had a few highschool girls that didn't want to work, a guy with a huge ego that didn't want to work, and randomly we would get job shop employees I would try to train.\
Every. Single. Time. We. Would. Get. Someone. To. Train. Our. 1st. Shift. Managers. Would. Take. Them. To. Do. Some. Other. Random. Shit. Why would they ever send them to us in the first place? Oh, that person was hired for put away? Why did you send them to me then? Why did you waste 3 days of my time? Who in this god forsaken place is in charge? When we did try to efficiently make multiple orders to get more work pushed through our put away department would get overwhelmed and we'd get yelled at for doing our jobs. Oh also, put away before the move was literally right next to processing. Now it was a 2 minute warehouse walk over broken stone floors, dodging the puddles and water barrels because of our completely unfixed roofing, all while either carrying full boxes of cards or a broken wheeled cart full of orders. Whoever designed this warehouse move was incompetent in my opinion, good lord. Eventually 1st shift had othered us to the point that they made the decision to take every 2nd shift processor out of the department and move them to shipping. I sat in a meeting with our floor manager as I was told that all of my years of processing were being thrown in the trash because my company couldn't manage itself out of a paper bag, and keep in mind I was personally responsible for evvvvvvvvvvery important processing task at this point. The funny thing? I was immediately texted by the main manager of my department that "they didn't mean me" and the aforementioned floor manager approached me the next morning and basically begged me to stay in the department I was just being kicked out of. I wish I could have been an ass and left them out to dry, but I carrrrred. I absolutely loved that company, I've told the daughter of the original owner I'd work for minimum wage and still be happy there. I'd told several of my revolving door managers that same thing, so I ignored all the BS and I kept doing what I did well.\
All this leads into Troll being bought by an outside buyer. I was personally dying for literally any amount of change at this point. We were told in a big company wide meeting that a new buyer was entering the fray and that they'd have full control of what they wanted done. Soon enough, he had several people he'd planned with personally coming in to take stock of our current situations, didn't like what he saw, eventually did massive layoffs including many of the people ruling processing at the time, and setup yet another person that didn't know all of the processing tasks to be in charge again. Surprisingly things were okay for a while, but still with their shenanigans. Executives up front kept calling for ways to fix our efficiency, which pretty much summed up to "don't do half of the things you're supposed to do like grade and sort, and fuck put away they can fix it", so that was fun. And soon another bigger layoff occured and then things finally settled down for a little while at least. It then became a situation of dude-bros handling our incoming product, always struggling to get things on time, and me and a few other people doing everything important when it comes to new releases as always. It was still way better than the incompetent years prior, and I was at least able to push myself in ways I wanted to. I can proudly say I've worked a 24 hour shift as I stayed over to do most of a new MTG release and all of the sealed product I needed to do as part of Distro all that night. Good times, good times.\
I'll go ahead and wind down from my ego fueled(?) ranting to say that I'm no longer a part of the company I'd worked at for 7.5 years. I was at the forefront of a layoff a couple of months ago, and it seems like this most recent layoff has brought that company down to an absolutely astoundingly low employee number, which I won't be saying here. I will personally say that they took all my hard work and patriotism from these years and told me they couldn't afford me anymore. Let me fully clarify, leading up to my being let go I was struggling to make it to work everyday on time. I recently moved in with my girlfriend who lives right up the road from the place I worked, but I had to come home everyday for lunch to help out as much as possible, and I struggled with the new schedule of getting up for work honestly. And that would have been fine for me to just make up any missing time at work, but every month since the year started I've been sick. Strep throat, covid symptoms, rashes from the antibiotics I've learned I'm allergic to, and the dog we tried to adopt bit onto 2 of our dogs and I totally ruined my finger tips trying to pry it's jaws open out of desperation. At the end of the day, the leadership at my old company decided I wasn't worth it so here I am. Anyways, I wanted to tell my little disorganized story of my years working at my first job, hopefully the parts I was willing to share makes someone else's head hurt in exasperation and giggle at the incompetence as much as I have over the years.

Hello,
I am coming here to hopefully get some guidance on any of your experiences going through the testing process with ANA. I am a 34 year old F, mother to a 2 year old. I have a history of severe anxiety, asthma and contact dermatitis/ eczema and arthritis runs in my family (osteo). Since having my son, my immune system has taken some major hits. At 2 months pp I had covid, a month later I had shingles. When my son was 1.5 years, I had a gastro parasite (Giardia) and then recently just got over gastritis. I have had countless colds/ flus along with joint pain in my hands, fatigue and muscle aches in my legs and now dry eye which lead me to believe I have something wrong with my immune system.
I went to the GP after complaining about these symptoms multiple times (was not taken too seriously prior as all regular labs including inflammatory markers have been normal other than low ferritin due to heavy periods). She decided this time to test me for RA Factor, CCP, and ANA. My RA Factor and CCP were negative but my ANA was positive at 1:160 Homogenous. 1 day after taking this test I came down with a horrible flue (102 F) as well as the worst sore throat and ear pain. I went to the doctor who said I had a throat and ear infection and prescribed me antibiotics which cleared things up in 4-5 days.
My questions are:
A) Can a bacterial infection throw off a ANA (I am seeing mixed answers via google)
B) I am scared I could possibly have lupus given my pattern and moderate titer score. I see that a homogenous pattern is tied to SLE. I have never had a malar rash or some hallmark indicators of lupus other than the occasional joint pain in my fingers and fatigue and dry eye. From you experience, was your pattern accurate and helping to diagnose a AD?
I would not be surprised if I have some sort of autoimmune disease but I do not see Rheum for 4 months and I am terrified and confused as to what to expect next. I guess I was just surprised to see a correlation to SLE on my test. Am I over reacting?
Thank you for any much appreciated advice you may be able to give me.

Hello all,
**I've seen a lot of similar posts to what I'm about to write, and I've labeled this as rant/vent, because I couldn't select more than one flair but I feel like I encompass a lot of things in this. My s/o and I have been following this Subreddit for a few weeks now and have found some very helpful posts in here, thank you all who contribute for what you do and continue to do.**
I am a male, 27 years old, and my fiancé 21 female, are on this journey to finding out exactly what's going on with her, and through a lot of research, word of mouth, stories, and the such, we do believe that there is a high possibility that she may have Endo. We are still early in the testing and what not but everything that we've read and researched seems to point to it. Now before I continue on, neither of us are MD's and we don't jump right to everything we read on the internet or current assumption is based off of negative findings so far, and our own knowledge of being in the healthcare field ourselves.
Our story goes back to January of 2023, where one night after a end of year party for one of our jobs we were staying at a hotel in town and she began to have immense abdominal pain, nausea, pale skin, dry heaving and unable to get comfortable. It took a few of us convincing my fiancé to let me take her to the hospital. We are both in Emergency Medical Services and we are both pretty bad at being patients, but eventually she allowed me to take her to a local ED. After a wait and many hours in the ED, an regular and transvaginal ultrasound they diagnosed her with cysts on her ovary (oh yeah, helpful to add she only has one. She had to have one removed at birth due to some sort of complication.) They prescribed pain meds and nausea meds and sent her home told her to follow up with OBG. Well as said we are terrible patients and she never did, everything had seemed to subside for a while. Come June 2023 she begins having more frequent nausea and vomiting especially when eating, treated symptoms as needed and moved on. August 23, another episode of intense abdominal pain, pale, diaphoretic, vomiting, brought her to her knees while walking in the kitchen at home. Off we go to different ED than the one in January. Ultrasound, urine test, I believe another transvaginal, and an X-ray, all negative, diagnosed with mild UTI, given antibiotics and sent home.
Summer of 23 continues on and we get more and more frequent episodes of abdominal pain, nausea, vomiting, to the point she can't even make it to my truck after sharing a smoothie bowl at a local healthy living mom & pop shop. Only thing we had to go off of was cysts as diagnosed in January of 23, so finally get her to call OBG and make an appointment. We go to the appointment. Ultrasound, transvaginal ultrasound, in office blood work, urine test. They find gallstones, refer to GI, did all their testing the whole 9 yards for them, yup Gallstones, surgery to take the gallbladder out, all went well. That was in November of 23, December and January were fairly unremarkable with some left over pain from surgery and occasional episodes of nausea and vomiting after eating.
Late January comes around and we notice nausea and vomiting immediately after intercourse. Didn't think much of it because it was new and nothing else was going on. Couple more times of the same in January and then February came and everything changed drastically. More nausea and vomiting after eating, after sex, pain started getting worse during sex, even the initial penetration was painful, and when we could do it I'd be running to grab her a bag or bucket and she would just vomit profusely. Call OBG, they said it was a GI issue, fine, play the game and call GI, they bring her in, get set up and do an Endoscopy, and Gastric Emptying study. She has rapid gastric emptying and some common polyps in the stomach as well as mild gastritis. Nothing to write home about GI says contact OBG. Call them back, okay cool come on in. OBG finally sees her, does blood work for PCOS, negative. Urine test negative. She was set to have a general follow up with GI anyway, OB took blood work, to test for thyroid issues, came back negative, saw the GI we are no awaiting another Ultrasound this week, then CT, and then if CT is negative GI is doing colonoscopy to check all the boxes so he can send her back to OBG so they can focus on OB issues and leave GI out of it (or if they find something GI related then they'll work that route.) GI isn't convince he's going to find anything on her CT or Colonoscopy but said we need to check all the boxes.
Not sure what OBG wants to do if everything is clear on GI side. Thyroid has been tested twice, PCOS blood word just done, they're talking about Endocrinology for hormone testing, and then from there they aren't really sure. Talked about birth control options, fiancé doesn't want to do because every hormonal BC she was on when she was younger she did not do well, and while it may fix symptoms and problems short term, our goal is a baby, so we really wanna find root cause here. Being that she's 21 they really don't wanna do Endo surgery until it's the ONLY thing left which is understandable.
This journey thus far has been the most draining thing ever, and has been so heart breaking for the both of us. Especially not even knowing for sure if Endo is the answer here, but not knowing anything else either. We used to have such an active bedroom life and it's now non-existent, she feels bad because she wants me to be satisfied, and I try to not bring it up or when she wants to do something I end up usually just helping her with her needs because traditional methods cause too much pain but most of the time we don't do anything anymore. Since the beginning of May we have watched 4 of my co-workers have their first baby, we try to talk about possibly moving and relocating and then we get to the topics of needing to move to good school districts, and then it gets kind of somber because while we don't say it we are both thinking "What if we can't even have babies?" Top it off with watching her in pain, the nausea, vomiting, the abdominal cramps, the irregular or even non-existent periods, the headaches. I can't imagine what she is feeling, but man what a helpless feeling to watch somebody suffer and try to manage symptoms but the meds don't work. The isolation and alone feeling you have watching your buddies and their wives and significant others live their lives, have their babies and even just see the way they interact with each other, while you and yours don't even really get flirty or play around anymore because the desire was ripped away from one of you and try as you may you just can't seem to find the drive because there is none.
I'm trying my best to be supportive, and make sure everything she needs to do gets done, all the meds and Dr's visits, but I am nervous for what lies ahead, I'm nervous for the Dr visits, the tests, the battle with insurance, the possibility of what may become for us, and even the time alone. I've read the horror stories about journeys like this and how it can take years to get an endo diagnosis and treatment. And then my next fear is if they do the surgery and end up telling her she should have a historectomy..that's going to devastate her and I. I know it goes without saying but, this path, and hand that life has dealt to us and so many others, is not a fun time. Places like this help to know other have gone through it and come out the other side but it doe still very daunting, and isolating to say the least. I know this was long and I appreciate y'all for reading, I've talked to friends about this but...nobody gets it and how it feels on the patient side and the partner side unless you've experienced it.
Also quick side note I know as I've already set we aren't even sure if she truly has Endo, so if my post doesn't truly belong here I'm sorry, this group just has so many resources and as I said we feel that's the track we are on, it seemed like the best place to put it.
Be well everybody!

My experience as a patient at Cherry Hill Women’s Center NJ with a D&E abortion at 13w6d pregnant.
TLDR; very very kind staff, clean environment, professional clinic setup, 4 hour process, overall great experience as a patient.
My backstory: I’m over 30, married for over 10 years and have never had a pregnancy before. I have always been told by my doctors that i would never be able to get pregnant. I’m on multiple medications that can cause severe birth defects and i was not aware that i was pregnant until i was 12w5d. I had no idea how far along i may have been because i didn’t note any pregnancy symptoms except for tender nipples and vomiting a week prior to taking a test. I have always had a very inconsistent period and had frequent spotting on a regular basis. I had an US done & measured at 13w0days & was able to schedule this procedure for 6 days later so this abortion was done at 13w6days.
Emotionally this was very hard for me. I reconciled the fact that i would never be pregnant as a very young teenager. My husband and I decided not to pursue having children at the very beginning of our relationship and he still does not want to be a father. Initially I was very afraid to tell him that i was pregnant because i was afraid that him knowing i was pregnant would change his feelings about having children and that he would hate me for taking this away from him. I’m very fortunate in that he was resolute in his decision to not have children and he’s been absolutely incredible through this whole process. He said he would support me if i wanted to keep it but my medical reasons for wanting to terminate were valid and he was in full agreement that life is hard enough and intentionally bringing a deformed/disabled child into the world when life is already so hard just wasn’t the choice for us. He has been my absolute rock through all of this.
I did a lot of research prior to my appointment and I’m not going to lie, there are a lot of bad reviews on google that had me extremely nervous, making me feel like i was going to be walking into a back alley abortion and i was terrified that i wouldn’t be able to bring my husband with me for this whole experience. There is so much anti abortion propaganda out there and there are a lot of videos designed to make you feel like you are a bad person for “murdering babies” and trying to scare you out of going forward with the procedure, but if this procedure is the right decision for you, this place is the right choice to go to. Everyone is kind and professional and understanding. Not once was i made to feel like i was a bad person or making the wrong decision. I was met with understanding and support every step of the way. It is completely normal to be scared or emotional going into this. I have been a healthcare professional for over 10 years and am very familiar with preop/post op procedures and patient care and i was still very scared going into this appointment.
Scheduling experience: I used their online appointment request tool on a Sunday and Monday afternoon i got a text with a link for a hipaa compliant chat. I chatted with a very nice lady who was able to schedule me for the following Saturday. I wasn’t given any information other than to not eat or drink anything after midnight the night before and to be at the clinic at 8am Saturday. No one called, texted, or emailed any further instructions after that chat communication.
This is where my feedback for them to improve comes in. They really need to make it clear what to expect the day of the appointment: that we will not be able to have a support person come in with us because only the patients can be in the waiting room for safety purposes. They should be highlighting the process of the day with the multiple back and forth trips from the waiting room to the back and the different steps to expect. It would have been nice to know i would do paper work then wait then US and blood and vitals then wait then nurse for the history & going over the procedure then wait then the payment then wait then come to the back for preop and talk to the doctor then wait in preop then the operative area for the procedure then what to expect for the post op experience.
Clinic experience: Upon arriving to the clinic, the protesters on the front sidewalk were SO very nice to make the driveway more visible. -___- Unfortunately nothing can be done to remove them from a public walkway. The security guard comes to the door when you pull in to ensure you arrive inside safely. Please don’t let them deter you, don’t even look at them or acknowledge them.
I was greeted by the very kind security guard who had my escort sign me in and then i entered the office by myself.
The receptionist was very kind and provided me with my paperwork to fill out. The office was clean and quiet. After about 45 minutes i was taken back by a very kind employee (sweetest kindest human being ever with such a calming energy) who did my ultrasound and vital signs and did a finger stick to check my hemoglobin level and rH factor of my blood. I was then taken back to the waiting room for the next step.
30 minutes later i was taken back to speak with the nurse to go over my health history, medications, birth control options, and the procedure. The financial planner then came in and took my payment (we paid cash $750 for the sedated D&E, $65 for the depo shot we are fortunate to have the income to cover the costs but they do offer financial assistance ask the scheduler about it if you need it)& i was escorted back to the waiting room.
20 minutes later i was taken back by the first employee (the literal angel on earth, so so kind) who did my ultrasound earlier to talk with the Dr, who was also very nice, and i was given cytotec to place between my gums and cheeks to soften my cervix and prepare me for the procedure. I was then taken to the preop/postop area to put a gown cap and booties on, they let you keep your own socks on and it’s chilly in there so i recommend doing it. They put me in a recliner chair with a blanket and then about an hour after getting the cytotec, the nurse started an iv & gave me zofran since i was feeling nauseous. At this point i was having weird stretching bloating feelings in my uterus area with moderate to strong cramps, which i assume was the cytotec softening everything & dilating my cervix. I noted the post op nurses were very kind to the patients the whole time and met the loopy antics of the other women waking up from sedation with good humor and kindness.
The operative nurses wheeled me back to the procedure room in the recliner chair I was in and I was taken in to the procedure room and met the anesthetist and operative nurses. They helped me get situated on the procedure table and then the next thing i remembered was waking up in my recliner chair in the preop/post op area. They took me back at 10:45 and i woke up in the post op area at 11:12.
The post op nurse said i stood and sat in the chair on my own from the table to in the operative area as they don’t lift anyone there but i don’t remember anything between being positioned on the procedure table before the procedure and waking up in the chair in post op. The post op nurse gave me the depo provera shot i previously decided to take with the first nurse and helped me to the bathroom to get changed back into my clothes.
I felt moderate cramping, similar to period cramps on a heavy flow day, and had a good amount of bleeding and small clots present in the toilet. I came prepared and brought female pull-ups and pads so i put those on. My husband arrived to pick me up and the post op nurse gave me a 1x dose of antibiotics to prevent infections and went over discharge education. They escorted me out to the car and i was on my way home. I took 800mg Motrin as soon as i got in the car.
They had the security guard still at the front door and then a clinic escort in the parking lot keeping the protesters off the property and on the sidewalk.
I arrived for my 8:00 appointment at 7:30 and was in the car on my way home by 11:30. By the time we got close to our home 45 minutes later the Motrin had me feeling well enough to have a meal with my husband at the local diner.
It’s now 8 hours after we got home and i feel mild cramping after taking another dose of 800 mg Motrin. I would say the discharge is similar to a heavy flow day with small clots. My lower abdomen is visibly bloated but not very tender to the touch. (Until my husband wasn’t thinking and set Wawa bags with a half gallon of milk in them on my lap/lower abdomen -_-) I have a weighted heating pad and I’ve had it laying across my abdomen since i got home and it’s been so helpful for the mild to moderate discomfort I’ve had.
Timeline of events:
0730 arrived, security very nice, receptionist very nice 0815- taken back for US, VS, finger stick. Ultrasound tech very nice. 0845- nurse - history, procedure review, birth control planning. very nice and informative 0900- financial counselor very nice 0920- brought back by first US tech to see the Dr, cytotec inserted in cheeks 0930 changed into gown put in preop recliner chair, curtain dividers 1000- preop nurses very kind, playing fun music, joking with patients during their postop grogginess 1030- iv inserted 1045- took back to the procedure room 1112- procedure done, in recovery, got depo shot, iv taken out, got dressed 1130- discharge education and went home. Moderate period like cramping.
Recommendations: - ask as many questions as you need to feel comfortable, they will take the time to answer them - It’s normal to be nervous but you don’t need to be afraid to come here. Everyone was kind, understanding, and professional there. - Your decision is the right decision. Period. No one else gets to make it for you. - It doesn’t matter if you are young or older, single or married, have no children or already have 10 children, this decision is yours and your rights - Hydrate well the night before. I made it a point to drink several liquid IV’s late the night before knowing i couldn’t have anything to eat or drink after midnight. It will be very hard for the nurses to get an IV in your vein if you are very dehydrated, the more you drink the night before, the better your veins will be. - Bring your own pads or even female pull ups whatever you prefer. They do supply you pads but they’re the big huge thick ones that most people hate. - Have Motrin ready to take as soon as you’re done. - Get a heating pad for afterwards it really is soothing. - Walk as much as you can, it helps with the pain and swelling and helps get the clots out. - Firmly massage over your uterus area it will help get the clots out and help your uterus shrink back down to size faster. - If your BMI is over 40 they won’t be able to do an asleep abortion there since they don’t have advanced airway management there. You’re a higher risk of respiratory depression during sedation when you’re overweight. I wasn’t aware of this until i talked with the history nurse. Luckily i was right at 40 and the anesthetist cleared me. - If you need to be sedated they will make you have someone sign you in and sign you out. But they can’t come inside and wait with you. You cannot drive yourself. - They’re going to tell you not to put anything in your vagina for 1 week post op- no tampons, menstrual cups, no sex, nothing internally placed. Also no swimming or sitting in a bathtub for a week. This is all to prevent infection. You want the drainage to drain and not build up bacteria inside you. - You are going to be more fertile after the procedure. It can take 4 weeks to get your period again, you can get pregnant before you have a period, use birth control! They don’t do IUD insertions there so consider getting birth control pills or the depo shot while you’re there.

Hey guys, wanted to make a post to see if I could help anybody out. Short backstory on myself I am now closing in on 3 years post infection and I'm doing a lot better today than I was even a year ago.. I've been through many ups and downs with this post Infectious IBS and I see a lot of new people and I really feel bad for them when I read these posts. So I wanted to put a few things together that might help some people get through.
You're going to be in for a fight...
To me it seems like most of us end up on this subreddit looking for answers because maybe you don't feel right after treatment. Let me be the first to say. It's normal to not feel normal post infection. Post infection IBS is a real thing and can feel almost as bad as cdiff some days. What the doctor probably didn't tell you is that the road to recovery can be long. Sometimes it's not but it's not abnormal to take months even years. Let that sink in if you are in for the long road but don't let those feelings get the best of you for to long. Cdiff is a tough diagnosis but it's not a death sentence. There is a cure and it is expected to lead a normal life post infection.
We are all different
If you search the subreddit you are going to see a lot of people suggest a lot of different things. Some of those things might help you some those might not. Just like everything else in life ..we are different and unique in our own way. Try these things but don't feel down if they don't work for you like everybody else. Think of it this way. Something dusturbed your microbiome ( antibiotics, anti acids etc) and chances are you treated the cdiff with some sort of antibiotic (vanco,flagyl or dificid). So here you have two instances that completely altered your microbiome. You got a nasty infection and then your nuclear bombed your gut with a strong antibiotic to kill off the c diff. But antibiotics don't just kill bad bacteria. They kill almost all bacteria. So all the food that you ate throughout your life to this point,All of the tolerances that you built up throughout the years might have gotten wiped out with the treatment for cdiff. So you can't go back to eating normally right away. You have to slowly introduce your old diet. And because there is no way to tell what bacteria got wiped out from your stomach, there is no telling what bacteria you need to rebuild your gut. This is why we are all different. Some of us might be lacking in one side of things but but have enough of the other.. some of us see benefit in fiber. Some of us don't. Most of us live by florastor But some of us find it makes our symptoms worse. Just like everything else, we all don't have the same road to recovery. But don't be scared. Try different things and pay attention to your body and slowly introduce things that help until you get back to a better spot.
Enjoy The good days
Throughout your recovery, you're going to feel like you improve one day and then you go right back to the drawing board the next day. This is Post-Infectious IBS. One day you can eat cheeseburger and think you're cured and then the next day you take a bite from an apple andThe floodgates open lol. It's normal to feel like you're taking one step forward and two steps back. You might go through a period where you think you're cured and then boom you have symptoms out of nowhere. It is important to get retested to make sure you aren't relapsing but do not be scared right away. Flares are going to happen. Don't let them get you down. When you have a good day, enjoy it. And don't worry about tomorrow. Just take it one day at a time and before you know it you will find a new normal. And don't forget, it is normal to get diarrhea from time to time. If you've ever been to a public bathroom, you realize this is the case lol. So many different things affect digestion. Not enough sleep,Not enough water Not enough fiber or even expired food can cause diarrhea. The difference between us and normal people is that these moments have us thinking that we're relapsing but chances are that is not the case. A relapse can happen but it is unlikely if you make it past the 3-month mark.
If you want it, fight for it.
This might be a little controversial but this is what I find to be true for me. Just like I said before c diff and its treatment nuked your stomach. And if you really want to introduce something back into your system. You're going to have to go through it. Using myself as an example. I drink a 5-hour energy drink every morning. Because I need caffeine to get through the work day. I waited a few months after treatment to try it out but I slowly introduced it back in. And yes it has caus ed serious diarrhea some days lol. But I kept doing it and I kept trucking through it. I started off with a sip that instantly took me to the bathroom. Today I drink one every morning with no issue And if you read side effects of 5-Hour energy drinks. Diarrhea is right. I feel like we can build up a tolerance to anything that we want. But some of the tastier stuff Like cheese, fatty foods and sugars are hard to digest in general and you are going to have to go through it to have it in your diet. If you really want it. But you can also take this moment to rebuild a healthier diet from scratch. But it's all up to you and what you want to eat from now on. You can build a better relationship with food if you want to. Like I heard one comic said not every meal can be delicious. If every meal is delicious, that's not healthy lol.
And that's it folks. Sorry for the long post. Just hoping I can help somebody out who might be struggling with mental health post infection. Remember this is a fight and you have to fight to get back to where you want to be. It's a long road with many ups and downs but you will make it through. There are many methods that people have used to get back to normal and new ones are being discovered every year. The microbiome is a fairly new science and we are finding out more things every year. So don't lose hope. Keep your head up and don't let c-diff take any more of your life away. You will get back to normal one day 🙏.

Context- I've hit a wall. Chronic Illness has taken my life. Frankly if I had all my illnesses but just no hormone issues, constant UTIs, constant and severe pain from endo, endo migraines... I wouldnt give a damn about POTS, EDS, MCAS, MAY-THURNER! I say "Endo" but i cant even get a diagnosis. The constant trauma from doctors, and i mean trauma. Full PTSD flashbacks to IUD procedure, and getting yelled, gaslit, painful vaginal ultrasounds... i cant do this anymore. Losing my memories! I am in so much pain i lose my memory on the week of my period and time is meaningless the two weeks leading up.
I take 10 200mg ibuprofens for my periods (at once every 6 hours, decreasing by 2 or more each time). I am not on my period, just having pre-cramps and suicidal, I just took 10 on an empty stomach. I know the risks, danger, etc. i just dont want to be here anymore. What long-term effects could this have? Be straight foward, what happens after an ibuprofen OD, what "life-alterimg" issues will it cause if/when i survive? I figure this might help disuade me, or at least try harder at seeking another therapist and alternatives to Ibuprofen for periods too? idk.
RELATIONSHIP issues I have a partner and he is kinder than anyone. He gives when there is nothing to be gained, he doesnt base morals on religion, he views me as a human being (which i dont feel like i am most of the time). He is everything to me. Which is why it breaks my heart to dissapoint him. I tell him i cant do this anymore and im going to kill myself every month. This past month its been a UTI+Yeast infection combo that took my entire time off my period the one week out of extreme pain I have and it burned it. On top of being told i was "wasting my time" and hung up on by my gynecologist when I told him I was allergic to the antibiotic he perscribed only for the UTI. He said the itching was "stress". And he didnt even do a swab, he just pushed on my "endo" spot on the back left of my cervix and when I screamed he rolled his eyes at me.
Q- So much fucking trauma. Seriously when does it end? What therapist WORKS!? Recommendations for specific qualities to look for in a therapist, certifications, websites, etc? It keeps happening, but im also not processing any of it and it just keeps building up.
Anyways... my partner, who is my world. I did not sleep last night as my hormones are fucked up (I have 1st trimester pregnancy levels of prolactin even though i'm not pregnant, never have been, cant be) but he was sad because he fell asleep hugging me and after i napped for an hour i got up at 11pm and left until 2am. He was supportive asking to talk (i was deeply dissasociated) i spoke with him just saying "its useless" "there's no point" he does not believe that my pain will never go away (it has only gotten worse over time and 8 doctors have told me there's nothing else they can do for the past 2 years now) but he has this hope and it feels like he uses it against me almost? Like thats not what I need. I want to end it all, dont tell me "it's not going to be bad forever." because IT IS for this, and I feel im the only realistic one about it because im living through it. It feels dismissive and upsetting. I say "forget it" "you'll never understand". We spoke in circles more and more, he just doesnt think its "over" and I have physically, mentally, emotionally, spiritually (not religious) reached my fucking breaking point. In fact I think I reached it a year ago and it has only gotten worse. Well, he was upset i kept him up until 5am, i felt horrible because i just want to force myself to not do this shit. The more i fight PMDD the tighter the barbed wire coils around me. I said im sorry, we went to bed. Amd he said "we can talk, its just we're not getting anywhere." oh my bad, let me just 🥳 , like?? what. Well he got his braces off thus morning and I wanted to be there!! So badly!!! I know its stupid and small, but it meant a lot to me! But I was in so much yeast infection pain that i couldnt move... i wanted to die thus morning. Its afternoon that he woke up, came into the other room where i was after i ignored his hellos and goodmornings and talked. It was all the same bs.
He says "why dont you go home" "at least rot at your house if you arent going to do anything to help yourself." i get it. But i cant snap out of it like that.
I finally said,
"i'm disgusted with you."
and left the room and took 10 ibuprofens.
How do i tell him how to make me feel better? like i cant figure out why his words feel dismissive and hurtful. They spiral me worse and he expects "doing things" like watching One-Piece to make me feel better. I LOVE one piece... when im in pain i forget what we watch because im so far gone. Any advice? Any ways to tell him how he can just support me? Any ways I can change my mindset? i dont know. Reddit do your thing (*tumble-weed sounds because this post is too long lol) sometimes i dont even have humor left tbh... i feel like nothing but i want my partner so badly to be happy and not burdened.

Hi everyone. 23F here, with almost a year trying to figure out what's going on with my body. I was diagnosed last October with Chlamydia. During this time, my boyfriend and I had gotten treated (before anyone attacks, we had just started dating and were seeing other people prior). We have both been clean since but the only reason I decided to get tested was because every time we had sex, I would bleed.Sometimes it was a little bit and sometimes it was a lot.The sex could be very vanilla or rough and still- blood. It's been months of doctors appointments and saying to "just wait it out you're healing" and no one has helped. I also ONLY bleed during sex. My periods are all regular and have been because I am on birth control (the pill). Until I finally found a gyno that wanted to actually help me. She did a endometrial biopsy on me in office and my boyfriend was there with me. I CRIED because of the pain but she diagnosed me later with chronic endometritis. Both of us confident that this is in fact was what was wrong with me, she prescribed me antibiotics for two weeks to treat this. I was hoping this would be the final steps to me going back to normal after almost a year... unfortunately it did not work. Our next plan is to do a hysteroscopy to check for uterine polyps and I'm praying that this is the last and final thing that helps me solve my problem. I'm honestly thinking if the hysteroscopy isn't the solution to go off the pill and switch to something else or maybe just get off bc entirely and see what happens then?
Each time my cervix has been checked, I have been told it looks healthy, nothing else is wrong. All tests have been ran. I only bleed the first time I have sex, but the second round all blood is gone. My boyfriend has been the most supportive through this but personally it causes me stress, embarrassment, and frustration. If anyone can please share any similar experiences, thoughts, opinions, tips, or even kind words I would truly appreciate it! 🤍

TLDR: Here is everything I've tried for suspected hydrogen/methane SIBO. This is not medical advice intended to treat or diagnose anyone, just my own case study.
I didn't take all of these at once, I usually took no more than 2-4 herbs at a time. For extra liver safety when taking multiple herbs at once, look up CYP interactions between the herbs and any existing medications you take and avoid taking combinations that might interact (or consult with your doctor). Most of the supplements I used are from Thorne Research, Pure Encapsulations, Metagenics, Organic India, Life Extensions, and Designs for Health. Research your brands carefully; the supplement industry is largely unregulated.

Helpful

Bolded are the most helpful; interventions in which I noticed a difference almost immediately.
Herbals:

• Berberine (works best on empty stomach)
• Allicin (works best on empty stomach for me, but causes reflux and gastritis after awhile so I can only take it for a couple of weeks at a time)
• Neem (1000mg, with meal)
• Oil of Oregano (Very strong...I caution against jumping to this one immediately. I always took with meals since I couldn't tolerate this on an empty stomach.)
• Olive leaf extract (empty stomach)
• Grape seed extract (empty stomach)
• Nigella sativa extract (empty stomach)
• Milk thistle (silymarin)

Motility agents:

• Ginger (specifically MotilPro, but it eventually caused heartburn and LPR for me so I had to stop)
• Triphala (empty stomach)
• Magnesium citrate (up to 400mg per day, although I usually take 100-200mg, or 300mg at most)
• Artichoke extract (empty stomach)
• MCT oil (i'd take a teaspoonful whenever i was feeling particularly backed up, as an emergency treatment)
• spoonful of olive oil on empty stomach in the morning
• dark chocolate (Double edged sword as this also increased histamine reactions for me. Also need to be careful what dark chocolate you buy because many sources of chocolate have high levels of heavy metals in them.)

Fiber supplements:

• Bimuno
• Sunfiber

Digestive aids:

• Betaine HCl with pepsin (I was taking up to 6 500mg pills per meal at one point, and tapered slowly off of that as I started producing more stomach acid. Stress also lowers the amount of stomach acid you produce. The die-off from taking 1 pill of this for the first time frightened me and I almost didn't try it again, I got very dizzy and almost felt like I was going to faint. I'm very glad I tried again.)

Lifestyle changes:

• EMDR or IBS focused meditation
• Walking, running, or other forms of low/medium impact cardio exercise
• Squats/deadlifts (can trigger bowel movements)
• Sleeping before 1am
• Sleeping > 6 hours a night
• Not eating 3-4 hours before bed
• No snacks between meals (good for motility)
• Whatever activities or changes you can do in your life to reduce stress
• Singing or karaoke (stimulates vagus nerve, self-soothing)

Dietary changes:

• Avoiding dairy (How do you think methanogens got into your gut?)
• Increase variety of plant foods - eat the rainbow, and eat organic if possible, or at least avoid the Dirty Dozen
• Specific foods that encourage the growth of beneficial bacteria in your gut microbiome: walnuts, kiwi, pomegranate, broccoli sprouts, legumes (lentils and green peas being two of the most easily tolerated ones, especially if you didn't previously eat a lot of legumes), sweet potatoes, spices (black peppercorn). There are many more beneficial whole foods, these are just some of my favorites that I try to eat every couple of days.
• Eating something like the mediterranean diet (low to medium fat, low to medium protein, medium low-glycemic carb intake, high in fiber, plants, spices, fruits, and polyphenols) turns out to be healthiest for your gut microbiome - everything in moderation, no major restrictions in diet

Probiotics:
I am especially picky with probiotics because I noticed increased histamine/MCAS-like reactions to some probiotics that I've taken in the past. I try not to take any probiotics these days that aren't single-strain. The strands below should all be non-histamine producing or releasing strains.

• B. longum bb563
• B. coagulans MTCC 5856 (Lactospore)
• B. infantis
• S. Boulardii CNCM I-745 (Florastor)

Biofilm buster:

• Nattokinase (be careful taking this if you're on blood thinners)

Didn't notice a big difference, but potentially helpful

Bolded are interventions that I felt were more on the "potentially helpful" end of "no difference" for digestive issues, or things that I would consider trying again. Some of these I took for their adaptogen or mood-boosting effects, hoping that it would lessen stress and help with stomach pain or reflux, but ultimately I didn't notice a huge change from taking them. I'm no longer taking most of these, and of the ones I've continued taking, I'm taking them for reasons other than digestive health.
Herbals:

• Atrantil (2x pills per meal)
• Andrographis
• Artemisinin (another one to be careful of taking long-term, i suggest no more than 2 weeks at the most)
• Fenugreek
• Asafoetida (mostly used in cooking, great for making legumes easier to tolerate)
• Cinnamon
• Parsley oil
• Quercetin (helped with increased histamine reactions caused by probiotics but didn't do much for stomach problems)
• Gymnostemma
• Pomegranate extract (Some research actually shows that this can decrease acidity in your stomach, so be careful about taking it if you already suspect low acid. I always take this for a couple of days when I notice any gastritis symptoms and it helps a lot with that.)
• Green tea extract
• Sulforaphane (careful taking this for longer than 2-3 weeks at a time, stop immediately if you start feeling any pain in your liver)
• Apigenin
• Tumeric/Curcumin (caused increased reflux for me too)
• Cranberry extract
• Ashwagandha
• Mushrooms (reishi, lion's mane, chaga, turkey tail - some of these actually increased constipation for me)
• Astaxanthin
• Bittermelon extract
• Deglycyrrhizinated Licorice
• Slippery elm
• Marshmallow extract
• Aloe Vera extract

Fiber:

• Arabinogalactan
• Acacia fiber
• Glucomannan
• Apple pectin
• Flax seed fiber
• Psyllium husk (Taking too much of this (or any fiber) can actually increase constipation too.)
• Beta-glucan
• HMOs
• Modified citrus pectin

Other supplements:

• Inositol (Didn't have any particular improvement in digestive issues, but I've continued taking after noticing increased mood and wellbeing)
• Colostrum (empty stomach in the morning)
• Magnesium L-threonate
• Magnesium glycinate (hoping it would help with sleep, but didn't really notice much benefit)
• L-glutamine
• Vitamin C (reducing severity of histamine reactions)
• Iodine + Selenium
• Zinc L-Carnitine
• Vitamin B12 (I still take about 1000mg once a week, just because I don't eat that much meat)
• Vitamin D3 + K2 (I still take this because I don't get that much sunlight)
• Omega 3 Fish Oil
• Phosphatidylcholine
• Ubiquinol
• D-Limonene (tried for acid reflux)
• Sodium Alginate (tried for acid reflux)

Digestive aids:

• Swedish bitters
• Digestive enzymes
• Beano

Biofilm busters:

• Serrapeptase
• Klaire Labs Interfase Plus

Probiotics:

• Biogaia L. reuteri DSM 17938 (I made yogurt with this too and also didn't notice a huge difference...it may have actually increased my gas a little, as many lactobacilli seem to do)
• Pendulum Akkermansia (there's chicory inulin in this as a prebiotic which might cause some symptoms for people)
• B. subtilis
• Other various bifidobacterium strains

Possibly harmful

• Any lactic acid bacteria probiotics or fermented foods - kefir, kimchi, yogurt, sauerkraut
• Processed foods
• Seed oils
• Sugar alcohols (sorbitol found in prunes and apricots are often used to trigger bowel movements, but it doesn't seem to be good for you long term)
• Artificial sweeteners and even some natural sweeteners (stevia!)
• Inulin, FOS (feeds everything, including fermenting bacteria)
• Long-term FODMAP diet (reduces diversity of your gut microbiome over time)
• Low salt diet (Sodium chloride is one of your main sources of chloride. Guess what your stomach needs to produce HCl? That's right: chloride!)
• Melatonin (severely slows down gut motility and causes constipation for me whenever I take it, even at <1mg)
• THC/CBD (also slows down gut motility)
• Alcohol (literally poison for your gut microbiome...i indulge rarely, and only socially)
• Metagenic MegaSporeBiotic (caused me to have histamine reactions that lasted even after I stopped taking them)
• Overdosing on laxatives/increasing gut motility to the point of diarrhea

Didn't try but would consider doing in the future

• TUDCA
• Xifaxan/Rifaximin (I was never offered this or any other antibiotics by any of my doctors. I could probably have gotten even more second opinions or pushed harder, but I wanted to see if herbals worked first.)
• Phage-based probiotics
• Looking into pelvic floor therapy or checking to see if pelvic muscle dysfunction is a possible root cause
• Lactoferrin
• Moringa
• Tulsi
• More herbals (There are many more herbals out there that I haven't heard of or researched yet.)
• Prolonged fasting up to 2-3 days (Unsure about this, as research shows that fasting can increase Akkermansia...but interestingly, it also increases methanogen presence in the gut. The gut bacteria of anorexia patients is enriched in methanogens as well.)
• Elemental diet (I also think of this as a last resort because it'll really kill the diversity in your gut microbiome)
• FMT (if suitable donodoctor could be found, but from what I've read so far it can be a mixed bag of unpredictable side effects and therapeutic benefit)

This is a throwaway account and this post is a thank-you to this community and everyone who has shared their stories and approaches. If you take anything away from this, let it be that there is always hope as long as you're still alive, and "do your own research" - by which I mean, try to read actual scientific articles from pubmed or other journals to confirm what you're reading online or consult with medical professionals (google scholar is a great resource!). Above all, rely on your own judgement: don't abdicate your critical thinking to anything you read on the internet, including this post.
Here's my story. I was going through an intensely stressful period of my life 2 years ago, culminating in a junk food binge (I had nothing but ice cream, chips, and other processed foods for a week or two). Naively, I thought having some kimchi (probiotics are good right?) and various probiotics would make up for the recent binge. Soon after that I started having a bunch of symptoms:

• Extreme bloating after meals, sometimes I was so bloated I was nauseated
• Lots of burping, sometimes it would wake me up at night
• Very little flatulence, all the gas felt like it was trapped in my stomach or colon
• Constipation and a dull, nagging pain in lower left abdomen, near sigmoid colon (when constipated)
• Sleeping on my left side when gassy was uncomfortable and painful, it felt like I was lying on some sort of bubble, gas trapped near my splenic flexure
• Trouble taking a full breath when sleeping on my back
• Waking up in the morning with souacidic taste in my mouth and pain in the back of my throat from acid reflux due to increased gas
• Could not eat anything with FODMAPs in it without a lot of pain and suffering
• Increased allergies and histamine reactions
• Brain fog, fatigue and dizziness, especially after eating

I went to multiple doctors and gastroenterologists who just diagnosed me with IBS and told me to try the FODMAP diet. They refused to do diagnostic exams (endoscopy and colonoscopy) due to my younger age (mid 20s) and lack of occult blood in stool. I tested negative for H. Pylori, but I never ended up taking any SIBO-specific breath tests and mostly went by symptoms and how I felt. My guess was that I was mostly dealing with hydrogen and methane SIBO, as I never had sulfuric smelling gas or diarrhea (besides when I accidentally overused motility agents at various times).
I started with one of the standard herbal treatments recommended in this subreddit:

• Candibactin BR, 2x in the morning, 2x at night
• Candibactin AR, 1x with every meal

I did this for about 2-3 weeks and felt an almost immediate relief after the first week and a half, although the first couple of days were unbearable with increased die-off gas. In hindsight I'm not sure if I did the right thing going with oregano oil right off the bat. It's very strong and I think I may have permanently damaged my microbiome in some way, because after around 3 months of remission, I started to notice the constipation and pain in my sigmoid colon. What followed that was multiple rounds of different types of herbals as I reached a slightly more "stable" place and then relapsed repeatedly. I've listed all the things that I tried above. Most of my rounds were 4-6 weeks long, and then I'd take a break. Taking 2-4 herbs at a time seemed to be mostly safe as I had blood tests during my yearly physicals that showed no abnormalities and good liver numbers.
What were my root causes? I suspect high stress (slows gut motility, reduces production of stomach acid), improper use of lactic acid bacteria probiotics and fermented food (fermented food might be fine for people who don't have compromised gut motility, but the food just ended up sitting in my stomach and fermenting even more), and binging on dairy (big source of methanogens in the gut). All of my relapses can be traced back to attempts to fix things with lactic acid bacteria probiotics, fermented food, slipping and having dairy (one of my relapses was caused by a cheese binge!), or having another stressful period in my life where I'd start eating poorly, sleeping poorly, skipping meals, and not exercising.
After the most recent round, which was 5 months ago, I've been eating onions, garlic, and other FODMAPs with no problems. I have no major restrictions in my diet besides dairy: I eat nuts, fruit, meat, mushrooms, sweet potatoes, oatmeal, etc, many of which I used to find difficult to digest. I'm still taking Triphala, 100mg magnesium citrate, B. longum bb563, Bimuno, and Sunfiber supportively, but no antibiotic herbals. I've been tapering off the magnesium citrate (down from 300mg/day) and have started to taper off Triphala as well. Current schedule: fiber supplements + probiotics in the morning, magnesium citrate with my evening meal, Triphala on an empty stomach before bed.
Am I cured? I'm not sure...this might be something that I'll have to deal with again in the future. But I'm definitely feeling more optimistic than I've ever been about it, and each time I finish a round of herbals, I've noticed that I'm getting closer and closer to normal. So maybe one day! Good luck to everyone reading this!

Some of you may remember me posting before. Apologies for length. I’ve a neurologist appointment this week after a 4-month break and I’m sort of afraid he’s just going to shrug and say nothing else to be done or reiterate it might be central neurological disorder (or fnd) or fibromyalgia. Looking for your experiences - does below sound like fnd to you with it all taken into account?
In Feb or March 2023, I noticed my legs starting to ache occasionally, especially when standing for longer periods and worsening balance. This got slowly worse with lots of new symptoms really taking off around August 2023 onwards as outlined below (should be said the right side of my lower body was the starting place of all this, and remains the worst. My left upper body tends to be similar or slightly worse than right side):
-Muscle pain - Moving about, my legs and often arms are always a 2-4 on pain scale, with near daily pain surges to 8 or 9 for 10 or 15 seconds (if it does, will usually be 2 or 3 times that day).
-Spasms/cramps - often randomly in my limbs, and for several months very concentrated in my right glute/thigh, then buttocks area, but more recently seem to be concentrated in my groin area (this is usually followed by the intense pain mentioned above).
-Increasing tightness in muscles that comes and goes, but comes more often of late. This literally feels like someone is squeezing me from inside my muscles (arms and legs).
-Perceived muscle loss in various areas, particularly in glutes and quadriceps, to a lesser extent in my biceps/shoulder areas. I say perceived as my neurologist disagreed the last time.
-Random throbbing/twitches all over body, usually will be for 10 or 15 seconds. They come and go, most days the last few months This has mysteriously died down the last few days, having been very active for months from perhaps November onwards.
-Sense of less sensation and/or clumsiness that comes and goes in some fingers and feet. Some tingling at times but was more prominent earlier in my symptoms. F or six weeks in September, I had weird mouth sensations (like I couldn't swallow even though I wasn't eating anything, some face tingling) and then a sore tongue that would twitch. These mouth/tongue symptoms have not returned thankfully since October.
-Body increasingly stiff and joints constantly cracking and sore. Like I'm losing all my flexibility.
-Daily tinnitus that was initially sharply painful each time it would happen for months, but now just ear ringing and no pain for months.
-Less common symptoms have included pin pricks and dizziness. Newest symptom in the last week has been increasing itching and literally a brand new symptom as I type - like heat dripping through my right thigh.
-I’ve had a ton of eye symptoms - extreme dry eye, meibomian gland dysfunction, feel like colors not as vivid, vision not as sharp, tons of floaters - eyes were fine before this bar myopia.
I've seen a neurologist and neuro-muscular specialist, as well as a rheumatologist and ophthalmologist. Despite many, many consults (where I pass all the reflex tests etc) and blood tests (covering stuff like muscle breakdown markers, heavy metal bloods, full autoimmune workup etc. including tests for Sjögren's), mris and emg/ncs, nobody has essentially found anything wrong, bar meibomian gland dysfunction in my eyes, and a lucky incidental finding of a high-risk dural arteriovenous fistula (successfully cured and not the cause of the symptoms I’m told). I’ve had two sets of full brain and spine mris 6 months apart, so I’m pretty certain it is not MS. The neurologists (at least to 4 months ago) were adamant it is not ALS. This is of course my number one concern, though I guess it’s unlikely given the negative EMG/NCS, the very random symptoms, many of which are widespread, come and go, and are pain-related, but I remain concerned.
I’ve been diagnosed at various times with fibromyalgia, central functional neurological disorder, and even relapsing polychondritis (my ear would go red randomly, but every test they have done for it has been negative). The neuro-muscular specialist did agree that I had muscle loss in one area I pointed out (my right glute), but suggested I get a personal trainer. This was in December and I said I’d been doing my best at gym for months (3-4 times a week, eating excess protein and calories) to no avail. Despite the pain and dysfunction, I’ve continued at the gym since then. Weirdly, it can often make symptoms temporarily improve (e.g. pain will be less or my function might improve slightly).
Outside of all these tests, I’ve done my own workups as my health provider can move slow/won’t agree to certain stuff. I got my own thyroid bloods and full vitamin and many mineral workup - all fine. I repeated multiple times stuff like CK, Aldolase, Ana etc in hopes of catching something when I’m feeling really bad. Nada. I asked for a muscle biopsy, but they say no so far. My own doctor was curious if I had a family history of myotonic dystrophy (I don’t). She wanted to test for it anyway, but the genetics part of my HMO said no on the basis that neurology hadn’t found anything.
Lyme tests were negative in-house, but I did do an external tick borne disease panel. It was positive for Anaplasmosis and Tick Borne Relapsing Fever. My own doctor sent this to their infectious disease unit for opinion, and they said such outside tests were bs (company was Igenex) and wouldn’t test for them. I convinced my doctor to give me a few weeks of Doxycyclene anyway. While I did feel it making some difference initially, I feel it was a hopeful placebo effect at this point as everything has gotten worse again. Don’t know how much stock to put in Igenex. The only difference, possibly unrelated, since going on antibiotics was that it seems I’ve been able to gain some muscle again more easily, just not in the areas I’ve been targeting (e.g. my biceps in general have gotten bigger but not the dents or fat where there should be muscle that appeared, nor can I got my right glute to be less hollow), nor my calf muscles less soft.
I’ve tried every supplement under the sun, even a week of prednisone (which made me feel worse). It’s all very frustrating and I appreciate it may seem fantastical I have no negative tests bar the tick stuff, yet here I am. I did have Covid, likely twice, definitely once, but was very mild.
Currently on Cymbalta (40mg) and LDN (4.5mg) - combined they reduce pain 10-15%. Gabapentin did nothing and did try a high dose for months (1500mg). I cut out all alcohol, gluten, dairy etc for many months and made no difference.
Thanks for reading - basically just concerned as to what to do next and what it all means for my future.

38yr old male here in USA struggling with all manner of neurological and muscular symptoms for months (undiagnosed), including twitching. I’ve a neurologist appointment this week after a 4-month break and I’m sort of afraid he’s just going to shrug and say nothing else to be done. I’d deeply appreciate any perspectives on what to ask fodo next - your experiences, not medical advice. I know this is long, but it's been a desperate saga.
In Feb or March 2023, I noticed my legs starting to ache occasionally, especially when standing for longer periods and worsening balance. This got slowly worse with lots of new symptoms really taking off around August 2023 onwards as outlined below (should be said the right side of my lower body was the starting place of all this, and remains the worst. My left upper body tends to be similar or slightly worse than right side):
-Muscle pain - Moving about, my legs and often arms are always a 2-4 on pain scale, with near daily pain surges to 8 or 9 for 10 or 15 seconds (if it does, will usually be 2 or 3 times that day).
-Spasms/cramps - often randomly in my limbs, and for several months very concentrated in my right glute/thigh, then buttocks area, but more recently seem to be concentrated in my groin area (this is usually followed by the intense pain mentioned above).
-Increasing tightness in muscles that comes and goes, but comes more often of late. This literally feels like someone is squeezing me from inside my muscles (arms and legs).
-Perceived muscle loss in various areas, particularly in glutes and quadriceps, to a lesser extent in my biceps/shoulder areas. I say perceived as my neurologist disagreed the last time.
-Random throbbing/twitches all over body, usually will be for 10 or 15 seconds. They come and go, most days the last few months. This has mysteriously died down the last few days, having been very active for months from perhaps November onwards.
-Sense of less sensation and/or clumsiness that comes and goes in some fingers and feet. Some tingling at times but was more prominent earlier in my symptoms. F or six weeks in September, I had weird mouth sensations (like I couldn't swallow even though I wasn't eating anything, some face tingling) and then a sore tongue that would twitch. These mouth/tongue symptoms have not returned thankfully since October.
-Body increasingly stiff and joints constantly cracking and sore. Like I'm losing all my flexibility.
-Daily tinnitus that was initially sharply painful each time it would happen for months, but now just ear ringing and no pain for months.
-Less common symptoms have included pin pricks and dizziness. Newest symptom in the last week has been increasing itching and literally a brand new symptom as I type - like heat dripping through my right thigh.
-I’ve had a ton of eye symptoms - extreme dry eye, meibomian gland dysfunction, feel like colors not as vivid, vision not as sharp, tons of floaters - eyes were fine before this bar myopia.
I've seen a neurologist and neuro-muscular specialist, as well as a rheumatologist and ophthalmologist. Despite many, many consults (where I pass all the reflex tests etc) and blood tests (covering stuff like muscle breakdown markers, heavy metal bloods, full autoimmune workup etc. including tests for Sjögren's), mris and emg/ncs, nobody has essentially found anything wrong, bar meibomian gland dysfunction in my eyes, and a lucky incidental finding of a high-risk dural arteriovenous fistula (successfully cured and not the cause of the symptoms I’m told). I’ve had two sets of full brain and spine mris 6 months apart, so I’m pretty certain it is not MS. The neurologists (at least to 4 months ago) were adamant it is not ALS. This is of course my number one concern, though I guess it’s unlikely given the negative EMG/NCS, the very random symptoms, many of which are widespread, come and go, and are pain-related, but I remain concerned.
I’ve been diagnosed at various times with fibromyalgia, central functional neurological disorder, and even relapsing polychondritis (my ear would go red randomly, but every test they have done for it has been negative). The neuro-muscular specialist did agree that I had muscle loss in one area I pointed out (my right glute), but suggested I get a personal trainer. This was in December and I said I’d been doing my best at gym for months (3-4 times a week, eating excess protein and calories) to no avail. Despite the pain and dysfunction, I’ve continued at the gym since then. Weirdly, it can often make symptoms temporarily improve (e.g. pain will be less or my function might improve slightly).
Outside of all these tests, I’ve done my own workups as my health provider can move slow/won’t agree to certain stuff. I got my own thyroid bloods and full vitamin and many mineral workup - all fine. I repeated multiple times stuff like CK, Aldolase, Ana etc in hopes of catching something when I’m feeling really bad. Nada. I asked for a muscle biopsy, but they say no so far. My own doctor was curious if I had a family history of myotonic dystrophy (I don’t). She wanted to test for it anyway, but the genetics part of my HMO said no on the basis that neurology hadn’t found anything.
Lyme tests were negative in-house, but I did do an external tick borne disease panel. It was positive for Anaplasmosis and Tick Borne Relapsing Fever. My own doctor sent this to their infectious disease unit for opinion, and they said such outside tests were bs (company was Igenex) and wouldn’t test for them. I convinced my doctor to give me a few weeks of Doxycyclene anyway. While I did feel it making some difference initially, I feel it was a hopeful placebo effect at this point as everything has gotten worse again. Don’t know how much stock to put in Igenex. The only difference, possibly unrelated, since going on antibiotics was that it seems I’ve been able to gain some muscle again more easily, just not in the areas I’ve been targeting (e.g. my biceps in general have gotten bigger but not the dents or fat where there should be muscle that appeared, nor can I got my right glute to be less hollow), nor my calf muscles less soft.
I’ve tried every supplement under the sun, even a week of prednisone (which made me feel worse). It’s all very frustrating and I appreciate it may seem fantastical I have no negative tests bar the tick stuff, yet here I am. I did have Covid, likely twice, definitely once, but was very mild.
Currently on Cymbalta (40mg) and LDN (4.5mg) - combined they reduce pain 10-15%. Gabapentin did nothing and did try a high dose for months (1500mg). I cut out all alcohol, gluten, dairy etc for many months and made no difference.
Thanks for reading - basically just concerned as to what to do next and what it all means for my future.

I am still NOT the Original Poster. That is u/amme04. She posted in AITAH, poor and TwoXChromosomes
Previous BORU posts are here, here and here. I removed some of the relevant comments to save space. New Updates start with ****\*

A reminder that this sub has the 7 day waiting period, so the last update is 7 days old. This is a LONG, dark post.

Trigger Warnings: attempted murder; domestic violence; stalking; possible child predation; attempted kidnapping
Mood Spoiler: bleak and will make you hate the justice system
Original Post: November 30, 2023
I don’t know if i watch too many crime shows or if I’m just paranoid so I’ve come here to ask. Last week I made chicken gnocchi soup. When it was almost done I started helping my daughter with a school project. She got us both a bowl and a few seconds later my bf runs into the room with a bowl and tells me to eat the bowl he has. I told him it was all the same and he insisted that he wanted mine because it had more chicken. Thinking back now I don’t know how he would know that considering my daughter dished it out. My daughter took the bowl he gave me and said she would eat it. He yanked it out of hand and said “no it’s for mom”.
I took the bowl and he went to the living room. I continued doing my daughter's project and told her not to eat the soup. 20ish minutes later I walked into the kitchen to pour the soups out and he was still eating his. He asked why we didn’t eat any and I said the cat got into it while we were waiting for it to cool down. He screamed “WHAT!? Was it your bowl !?! Cats can’t eat that!?”. I told him it was only a lick but he has been stressed out watching the cat like a hawk, obsessive even. His reaction was very weird.
These "accidents" all happened before the soup incident over the span of 6 months. It wasn't one after another in a short period of time. Since then my emergency money has gone missing. I keep money hidden just in case. I lost my older sister because she wasn’t able to escape a dangerous situation and I literally swore on her grave I would never be in that position. After the soup incident I went to get my money and it was gone. It was hidden and I changed the location every few months. I asked my daughter if maybe she found it and that if she took it I wouldn’t be mad because I knew she couldn’t have spent it. She said no. A few hours later she tells me she forgot but the other day her and my bf got pulled over and she saw my pink wallet in his glove box. I did not tell her which wallet it was in or that it was in a wallet.
I decided to ask him if he found it by accident. He asked me why I was hiding a large amount of money, “you know you could never leave me” and laughed. (He has never said anything like that before). I told him it was for my daughters Christmas. He said no he didn’t find the money but could use his credit card for gifts. I didn’t tell him about my daughter seeing my wallet in his car. Now here are a few other things that have happened in the past few months that seemed random at the time but now they don’t.
I have a severe allergy to latex. One day we were about to have sex and I glanced at the mirror we have by our bed and saw the condom wrapper was a different color. I stopped him because it wasn’t latex free and he said it was a mistake and just an older one he had. We have been dating for over 2 years and he knows how serious my allergy is. My epipen that I keep in my room is missing and I didn’t realize it. I didn't realize it was missing until I was searching for my money.
Another odd thing is one day he was following me down the stairs while I was carrying laundry and he kicked the back of my leg and I fell. He said he slipped but the stairs are wood and he was wearing his steel toe boots. At the time I thought it was an accident.
Am I overthinking this? My anxiety has been at an all time high. Do I watch too much true crime? Here is why I think I might be the asshole. We have a good relationship. He loves my daughter like she is his. We split all shared bills and we both pull our own weight around the apartment. We don’t fight. He has never so much as raised his voice at me. We are paycheck to paycheck but bills are paid.
I thought about going to my moms house for a few days and asking him when I get there when I’m safe about the money but I don’t have money to do that now. She is on a fixed income and can't help. I feel stupid for being scared. Last night I decided to check his car for my wallet and he caught me. I asked him for my money back and he tried playing dumb. I told him my daughter saw it there. He told me she was lying. I told him I never told her about the money or what wallet. He said he was a grown man and kids lie all the time. I asked him once more for my money and he said “I’m not giving you money to leave me”. I waited until he was in the shower to grab my cat and my daughter and we left.
I can’t take my cat with us to a shelter and the DV shelters are full. I was able to get us a night at a cheap motel. This exact situation is why I had money saved. I did everything right and now I’m screwed. I feel like I just blew up my entire life.
Yes I'm using a burner account and reading all the comments that I can.
Relevant Comment:
Several people accuse this of being obviously fake because events escalated too quickly and why would she be posting on reddit for advice:
"I'm not a character in a anonymous fucking story. I wasn't looking for advice, I was looking for confirmation I wasn't paranoid. You bet your ass I left as soon as he said my daughter was lying. Fuck off"
There is no consensus bot on AITAH, but it was pretty obviously NTA
Update Post 1: December 4, 2023 (4 days later)
A TL:DR; I think my boyfriend put something in my soup. After that incident I remembered a few months ago he almost used a latex condom knowing I’m severely allergic and I also remembered when he “accidentally” knocked me down the stairs. I started piecing things together and realized my epi pen was gone as well as a large amount of money I had hidden. My daughter saw my old wallet in his glove box and he denied it.
My post got alot of attention and my account was shadowbanned for a few days. I was able to appeal and get my account back because I’m not a bot or some AI. Now for the update.
The day after we left he sent me a picture of my epi pen and tried telling me it was in my nightstand the whole time. I tore that room apart looking for it so I KNOW for 100% fact it wasn’t there. He took it. He tried getting me to come back telling me I scared myself stupid and watched too many true crime TV. Something didn't feel right so I told him to put my money and epi pen in the mailbox. We went back and forth and he denied having my money. He then said “If we broke up you and Maria (my daughter) are no longer allowed in my apartment and will be treated like trespassers” and sent me a pic of his target practice sheets. I went to the police about the money and was told it was a civil issue. I was upset but wanted the rest of my stuff so I asked for an escort.
Yesterday I finally got an escort into the apartment with a cop and my landlord. He destroyed everything of my daughters and he ruined the laptop charger I use for work. No epi pen. My daughters medication and back up medical supplies were ruined. Our landlord let me off the lease without having to pay an early termination fee which is great considering I have no money. Motels are expensive. I don’t want to get rid of our cat. All shelters are full and this is scary as shit.
I’m sorry this is a shitty update but I know people wanted it.
Relevant Comments:
There has to be something that can be done about your daughter's meds:
"I'm beyond angry that nothing can be done. Insurance won't cover her medications or supplies until next month. She JUST got refills. I can get her meds but I'll pay out of pocket. I have no money. Since I couldn't prove my money existed I can't prove he stole it. I'm livid."
Restraining order?
"Nope not unless he gets physical with me. I should have let him hit me and I would have a lot more help available which is so fucked up."
Update Post 2: December 10, 2023 (6 days later, 10 days from OG post)
My OP got a lot of attention but then my account got shadowbanned and was temporarily removed. I just updated 5 days ago but this will be my final update because there is nothing anyone can do. I was encouraged to go back to the police station after my last update.
On Saturday December 9th I went back AGAIN. This time I printed out the threatening text messages that included the target practice sheets he sent, I explained in detail about the “accidents” proving he was trying to hurt me, and I even had my landlord put in writing that he believed our lives were in danger after seeing everything I was showing the police and let me leave my lease early. I brought in the destroyed medical supplies and medications.
The police said they had already talked to him and said he didn’t do any of it. He told them my daughter probably destroyed her stuff because she is “special ed”. She has very mild Asperger's but doesn’t destroy things! Since it was his word against mine they believed him. I didn’t have proof he stole the money or that it even existed in the first place. I was told the epi pen was my responsibility and they won’t do anything if it’s lost. I was told to “let it go” and acted like I was bothering the police with my “petty civil issues”.
I am so defeated and angry. My daughter isn’t going to have gifts for Christmas because I have to save for a new deposit on an apartment. We have been staying in motels while I was reaching out to DV resources. I can’t get help without a restraining orde police report. Every place is out of funds. He is getting away with everything and I’m so glad we got out because there is no doubt in my mind he would have gotten away with my murder.
I know this sounds like my last update but that is what happened…nothing new. No justice. No repercussions for him. He gets to stay in the apartment. My landlord offered me another unit across town but I can’t afford to move in. This exact situation is why I had money stashed away because no one has ever cared about me/us and I knew that. There is nothing else I can do.
Editor's note: OOP posted in another sub with the exact same information as above and no new update. However, she did add this clarification about shelters:
"All shelters are full. I found an organization who helps DV victims with housing but only if you have a police report and a restraining order. I guess they are tired of victims going back to their partner, safety reasons, or something. I was denied a restraining order because I had no proof. I’m scared, exhausted, and disappointed."
Update Post 3: December 28, 2023 (18 days later)
Title: I thought we were safe
Alot of people wanted a update so here it is. On Christmas he slashed my tires knowing I would have to pay out of pocket to replace them which I don’t have. Today he threw a heavy patio chair through the window of the place we were staying at to let me know he knew where we were and I was asked to leave for everyone's safety.
Except my daughter and I aren’t safe. I walked in the sleet/snow with my daughter and our cat and I felt vulnerable and like open prey so we came back to the police station to sit in the lobby until morning. Shelters are still full and I now have to disclose that he is dangerous anywhere we go. Police couldn’t find him but I know he has to be close.
I don’t know what his end game is.
Relevant Comments:
Can police direct you to a DV shelter?
"The shelters here are full so we are just sitting in the police station lobby. We are at least safe and warm so I'm grateful for that."
On donations:
"Donations aren't allowed here and my post could get removed because of it. I'm trying to stay awake and really just venting. I'm so frustrated that he keeps getting away with this shit."
Do you know how he keeps finding you? Have you checked for trackers?
"I honestly have no idea! He is supposed to have a new girlfriend too so IDK why he is messing with me and destroying property"
Reset your phone to factory settings:
"I got a cheap burner after we left. He doesn't have my number nor have I used it to call anyone so IDK how he is tracking me."
You said he sent you a photo of the epi pen after you left. How did he communicate that to you?
"He sent it through my email before I blocked it."
Update Post 4: January 1, 2024 (4 days later; a bit over 1 month from OG post)
Title: I found the air tag in the cat carrier
Please read my other posts for more context but a tl:dr; I’m pretty sure my ex was/is trying to kill me. There were a few instances that I wrote off as “accidents'' until I think he poisoned my soup that was specifically for me. On Christmas he found where we were staying and slashed my tires and threw a heavy patio chair and planter through a window. He still hasn’t been caught.
I checked everywhere I could think of and still couldn't figure out how he was tracking us. I blocked him on everything including email after he sent me pics of his target practice sheets among other things. I got a cheap burner phone. My daughter was out of school for winter break so he didn’t follow her or anything. I checked my car for a tracker. Still nothing.
I do not have an iphone so I couldn’t check whatever app a air tag is attached to. My cat is harness trained and wears a collar but there was no tracker. Until today I decided to “feel up” (sorry only way I can describe it) the carrier. I ran my fingers over every inch of it and felt a bump on the bottom soft side. There was no new stitching or obvious cut. He had to use a seam ripper along the stitching. It was undetectable and I almost missed it. He had to have had help because I’ve never seen him sew anything. Probably the same person who is letting him hide now.
If his excuse for the air tag was to track my cat he would have put it on his collar or harness because that is what he would wear when we go on walks/car rides. My cat would never go in his carrier unless I was planning on leaving for more than a few days. I have no idea how long it has been there nor do I know how far the tracker works but now we aren’t safe where we are, AGAIN. I feel disgusting and I feel like hunted prey. This is so unnerving and I’m so uncomfortable. Who the f*ck was I living with?
Relevant Comment:

I’m sorry but I don’t find it believable that he tracked you with an AirTag.

I don't know how airtags work and didn't say that is how he is tracking me, just that I found one. It doesn't make sense how he knew where we were.
Update Post 5: January 7, 2024 (6 days later, 5.5 weeks from OG post)
Title: I finally got the restraining order!
I’m hoping this update will make everyone as happy as it makes me! I was finally granted the restraining order. And we get the keys to our new apartment on the 11th. A place I can afford monthly and comes partially furnished. It’s in a super safe area right by my daughter's school. There is security!! We will spend our time living in our car until then and of course it has to be snowing but we are together and we have our kitty. This nightmare is almost over.
Update Post 5: February 2, 2024 (almost 1 month later)
Title: A restraining order didn't stop him
This morning he found me.
I've been sick as hell so after I dropped my daughter off at school I went straight home.
I didn't drive around to make sure no one was following me. I messed up.
He broke my nose and shattered my orbital bone. He is in jail. Sorry for this update ya'll.
Relevant Comments:
"Staying in the hospital for the night, I was pretty sick before this happened. My daughter is with a friend for the night. My landlord fixed the door as best he could and told me my cat wasn't in the apartment so I'm worried sick. I thought this was over, I'm so so so tired."
"I'm sure his mom will bail him out. Why can't he just move on? He took my money and my peace, what more can he take until he is satisfied?"
Commenter: Please pull your daughter out of her school and leave the state ASAP.

OOP: I so wish I could do this but we just moved into our new place. I should have just stayed with my mom (she lives in another state) but I didn't want to disrupt my daughters life too much. I have three dollars to my name so I can't leave.

You often can break leases without penalties in DV situations:

My previous landlord let me out of my lease without a penalty and my new one will too I just can't afford to move.

Update Post 6: February 4, 2024 (2 days later)
Title: Not being able to move even if my life depends on it
I know the importance of having money saved and I live within my means. How many of us is one disaster away from losing everything? A fire, job loss, a bank screw up, a late paycheck, illness, or someone stealing from you. I had money saved because I knew that any one of those things could happen and I wouldn't have anyone who could help me. And it did. Two months ago my ex tried poisoning me and stole the money I had saved. It’s been hell since. I was able to break my lease and leave. I went to my moms over Christmas break but I came back because I didn’t want to disrupt my daughters schooling and I underestimated my ex.
I was able to get an apartment through DV services very quickly which was a miracle. I know how hard it is to find housing and then try to come up with all the deposits a new place needs. I did it, the cards fell in my favor. But then I fucked up. On Friday I took my daughter to school and wasn’t diligent. I will usually drive around to make sure I’m not being followed. To be honest I started feeling crazy, paranoid, and angry I was wasting gas. Plus I have pneumonia and strep that I haven’t been able to pay for the antibiotics so I just went home to my bed.
He found me and broke my nose, shattered my orbital bone, and I have a concussion. I had a restraining order and he was arrested. I shared this on another sub and everyone telling me to move, leave, RUN. Except I can’t do that. It’s hard trying to explain that to people for them to understand because it sounds like excuses, like I like living in fear or something. I can’t pull money out of thin air. My credit card is maxed. I contacted DV services at the hospital and because I just got help, I can’t get it again.
The thing I didn’t know about abusive men is that they don’t just move on or stop. There are DV shelters but they are full. I wish people would understand that I know how serious this is but money doesn’t grow on trees. Even if a life depends on it.
Relevant Comments:
Will your parents really not help you?
I only have my mom who lives out of state. She is on a fixed income so she can't help me. We could stay with her but at this point I'm out of luck and nothing worth a damn to sell.
You need to disappear:
Honestly how? I'm not going to get anywhere on foot.
Update Post 7: February 15, 2024 (11 days later, 2.5 months from OG post)
Title: He was with me to get to my daughter
It all makes sense now. If you need more context please read my past posts. In my first post I said how we had a normal relationship and he was never abusive, controlling, never raised his voice. The money that he ended up stealing was money I had hidden since before he even moved in. I was not hiding money to get away from him. I was not afraid of him. I lost my sister to DV and swore I’d never have that happen to me only to end up in that exact situation. We didn’t have this spectacular love that was filled with insane chemistry, nowhere near a “love of my life” situation which is why I was so confused by how desperate he got.
After he got arrested his mom went on a social media rant because I “got her baby locked up” and knew we were sleeping in my car so was telling her followers that if they find me to call her. Very bold and insane. One of my exes friends saw this and commented “Idk if you should be sticking up for him, he needs serious help”. I don’t know how I caught it before it was deleted but I reached out to him on my fake facebook.
Every time they were drinking he would talk about her and then laugh it off. It made his friends uncomfortable but they chalked it up to the booze. Two weeks ago when my daughter came to see me in the hospital she was distraught. It made sense because I looked like hell but she kept repeating over and over asking me why he did this to me. I think there was more to this and I’m frightened to my core. Remember he stole my epi pen and money but he destroyed almost everything of hers and I didn't understand it because she had nothing to do with the breakup.
Why did he destroy her medicine? Why did he destroy her clothes? Fucking why? Dont abusers threaten their victim into not saying anything or something is going to happen to someone/something they love? I’m sick to my stomach even writing that out. I don’t know where to go from here, how do I even begin a conversation about this with her? We are safe. I’m not worried about him finding us because he is still in jail which is great because I’m out of money. He wasn’t desperate and crazy because he was losing me, I think it was because of her.
Update Post 8: February 20, 2024 (5 days later)
Title: My ex is getting bailed out tomorrow
I'm so angry and scared.
I wish I had faith in the justice system and with cops because they are supposed to protect, right? Except that isn't always the case.
I'm tired of being hurt and I'm tired of being scared. Anxiety is on 100.
It's exhausting fearing my daughter and I's life.
Update Post 9: February 28, 2024 (8 days later, 3 months from OG post)
Title: How can I feel safer at home?
I know a lot of people are following my posts and will be disappointed in hearing that my ex was bailed out. I’m still healing from when he broke my nose and shattered my orbital bone. I know a restraining order is just a piece of paper because he ignored it when I was attacked and the police aren’t going to save me. For security I only have a door bar that slides under the knob. I don’t have a ring camera and I can’t buy a pew pew until I have extra funds. He made me sell it a year ago because he was “uncomfortable” with it being in the house. Another red flag I missed.
My question is what can I do to feel safer that doesn’t require money? Every night my daughter and I push the couch in front of the door but I’m worried that if there is a fire we can’t get out. I have myself worried sick to the point of painful stomach ulcers. I tried talking to my nearest neighbor but when I started explaining my situation and how it would be great if she could let me know if she sees anyone around my apartment she got weirded out. Which I get.
Just looking for some peace of mind, will that ever exist in my life again?
Update Post 10: March 6, 2024 (1 week later)
Title: AITAH or was this just a mistake?
Editor's note: I removed the first part of this as it is a recap of the previous posts
I know this is all I post about and if you want more context you can read my past posts. I feel like I need to tell someone what is happening so that it makes it feel real and that I’m not just upset and crazy for nothing. My ex got out on bail last week. My daughter and I already left the new apartment we had moved into after he attacked me.
My daughter's school knows about my situation and knows I have a restraining order. Today my daughter got a call from the front office at school. The secretary told her that the pickup car had changed from mine to a new car. She was being told this so that when school let out she wouldn’t get upset when she didn’t see my car. The “new car” is the same one as my exes. It is a rare cacolor and she told me she knew it was his car. She didn’t say anything to the secretary or her teacher because she was instantly scared. It breaks my heart that she was in fear because she thought he had got me and was going to get her.
She was given the message hours before school let out so she spent all that time worrying. The last ten minutes of the day is when the kids can use the bathroom and clean up. She started crying infront of her whole class and when the bell rang she refused to leave her classroom. I was in the carpool line when I got the call from her teacher.
I have never seen her so upset and that is saying a lot because she was so upset when she visited me in the hospital. Face beet red, hyperventilating, snot everywhere, she had cried so hard she got a nosebleed. After they told me what happened I was livid. It all sounded like bullshit because the secretary never should have relayed the message without talking to me first since she said it was a male on the phone. As soon as the secretary looked my daughter up to find out which room to call she should have seen the message I thought I had saying no one should ever pick her up but me. No information should ever be released.
“He was never in contact with her so it’s not that big of a deal, it was a mistake” is what they told me. All he had to give was her full name and what grade she was in to get a message to her. They said that to me with a straight face while the bruises he gave me were very visible proving he is a violent man. I’m so f*cking angry. She told me she knew I didn’t get a new car because as much as I try to hide it from her she knows I’m broke. She thought she was going to have to go with him. She has been so traumatized and I don't know what to do. She wants to switch to e learning but since it’s not a medical reason and not a school wide restriction I would have to pay to rent the laptop. Which I obviously can’t.
The school is calling it an innocent mistake and didn't even apologize. I know I'm the only one responsible for my daughter and I’s safety but damn if people could stop jeopardizing it like it’s nothing and then acting like I’m the asshole for being upset because it was a “mistake”. He wasn’t there after school but he could have.
Update Post 11: March 7, 2024 (Next Day)
Title: He is never going to stop terrorizing us
Editor's note- This is an almost word for word repost of the above post. I've kept it here for the timeline but also to include relevant Comments.
Relevant Comments:
Commenter: I hate to blatantly ask but did you ever find your cat?

OOP: Hi yes I have my cat!

Commenter: Have you contacted your mother, does she know what’s going on? I don’t know what your relationship with her is like but would she willing to help in any capacity

OOP: The only thing she can assist with is a room for us to stay in which is great but not if I can't get there. My daughter is refusing to go to school. I don't know what to do.

*****Update Post 12: April 1, 2023 (3.5 weeks later)****\*
I've had a few people asking so I wanted to update. I can now confidently say that my daughter, cat, and I are safe and will continue to be from here on out. I can start rebuilding without fear. I'm not okay but we are safe.
Update Post 13: April 23, 2024 (3 weeks later, almost 5 months from OG post)
Title: I’ve spent the last 4 months running for my life
I just want to say that if anyone is going through something similar to me, you can vent to me. This is something you have to experience to understand how hard it is. I know there are DV resources but they are extremely limited. I had someone on here “checking in” with me and when I explained what was going on I was asked “why aren’t you stable yet” and it kinda took me off guard. Only a few people knew I was pregnant through this.
I left my home with basically nothing and went to a hotel and he found me, I went to another hotel and he found me, I went to a safe house for two nights where I was asked to leave because my ex was dangerous, slept in my car with my daughter, went to my moms out of state, came back to my home state because that is where DV resources helped with a apartment, he followed me back to my apartment from my daughters school, I was hospitalized when he broke my nose, shattered my orbital bone, and gave me a concussion. I had to leave that apt, back to hotels and sleeping in my car, and finally back to my moms. So much money feels wasted. I have the opportunity to be added onto her new lease but it’s a bigger unit and requires a first/last deposit (impossible unless I rob a bank). The pet deposit is already paid.
But I only have until the 1st or we are back to living in the car because we have exceeded our “visitation” days. A year lease where my rent would only be $500 a month, utilities maybe $150? I’d be saving so much money and be able to rebuild my life. We would all have our own rooms which means privacy! Even though we are all female, privacy is precious. I haven’t slept in a bed since the hotel beds but even then it wasn’t “my” bed. It’s been my car, hotel bed, or the couch. Even when we were briefly in our new place I still slept on the couch with it pushed against the front door.
I know all my posts are about the same thing, one thing after another, and yes it IS exhausting and repetitive but think about how I feel. I’m desperate for stability and I can’t get it because he took so much from me. It wasn’t until I was out of “our” house and away from him for me to see how much power he had over my life. It’s embarrassing. Even if I have to go back to living in my car I’ll still be around to talk and I’ll still be optimistic because I deserve good things to happen to me that aren't only in my dreams.
Clarification on the air tag:
There was! Someone helped him put one in my cat's carrier because he knew if I was going to leave, I'd never leave my cat behind.
Update Post 14: May 21, 2024 (1 month later, almost 6 from OG post)
Title: The vet gave my abuser my location
I want to say this was a genuine mistake and not done with malicious intent but I still need to vent about it. Just like my daughter's school letting my abuser give her a message, this was an accident but accidents put my life in danger and I’m exhausted. I post about my situation alot and despite a few users thinking my ex would find my reddit, I’m not worried about that. However, I am terrified of him knowing where I am. He has gone through a restraining order, police don’t scare him, and when he got/gets arrested he will just get bailed out. I knew the only way I could live a normal life was getting as far away from him as possible.
So I took my daughter and cat and moved in with my mom a few states away. I was 100% confident that he didn’t know where I was because they never met, we were actually estranged for a few years before my ex and I even got together. I started feeling safe. I stopped jumping when I heard loud trucks. I was starting to get comfortable even though not alot of time had passed.
A few days ago my cat's back legs stopped working and he lost control of his bodily fluids.I was working but my mom rushed him to the ER vet. There were questions she couldn’t answer so they asked if he was chipped. He is but I changed my number a few times lately so one of the two numbers was out of service so they called the second one. I forgot to remove his number, I know this is my fault. The vet called him to get information and he didn’t give any information and hung up on them. The receptionist said he called back about 5 minutes later and said “I know she doesn’t have money. Tell her I’ll save her cat if she comes home”.
He knows how much my cat means to me. He found me the first time I left because his mom helped him sew an air tag into the lining of the cat carrier. He knew if I was to ever leave him I wouldn’t leave my cat. One time my ex threw him out of the house to hurt me while I was at work he refused to leave the porch. My ex then tried squirting him with a water bottle and when that didn’t work, he sprayed him with the hose. He basically got waterboarded and still would not leave.
He is my soul cat. When I got to the vet and they told me what happened I had one of the worst panic attacks I’ve had in awhile. I’ve had my cat for ten years and he has never gotten sick or injured. He has a UTI and a fractured foot from falling. The vet thinks he probably got his foot hurt first and that led to the UTI since he wasn’t using the litter box. I noticed he was slightly limping a few days ago but I couldn’t get him into the vet yet. The UTI developed quickly. I was naive in thinking the vet would save a pet's life even if the owner can’t pay upfront but it isn’t like a human going into the ER.
I’ve spent so much money and time trying to get away from my ex while also trying to live a normal safe life for my daughter. Once again something happens and he now knows the city we are in. I’m not running again because I can’t. I don’t think he will drive up here because like I said I’m a few states away but man did this bring back my paranoia and irrational fear.
I changed the chip information but the damage is done, I was a fucking idiot for not doing it sooner. This is my fault, I'm so damn tired.
Relevant Comments:
Commenter: Why did they use the microchip to get your number? Did your mom not have your most recent number to give them or something? Could you not be reached at work? That’s just weird to me.

OOP: My mom was flustered because she knew the ER vet was going to be expensive and knew I couldn't pay but she couldn't answer any questions because she didn't know. Didn't know how old he was or if he had his shots. I can't take my phone into my work building and she didn't know the manager's phone number.
I was able to pay partial with scratchpay but not all which is heartbreaking. A broken heart and frustrating anger is what I feel too.

Commenter: I just don’t understand why the vet would go through the trouble of scanning the chip and calling the numbers on there instead of just asking your mom for your number?? Seems like a lot of grief could have been avoided and the clinic had to do more work to call a company and get the phone numbers.

OOP: I've had to change my number over 6 times in a three month time span, my mom didn't know it off the top of her head.

Commenter: If you are communicating with your mom it would be in her phone. If it changes so often, the last number in her phone would be more accurate than a microchip which is less likely to be updated. This is very strange.

OOP: I was at work, I can not have my personal phone on me and my cat was having a medical emergency. My mom didn't know how old my cat is or if he had his shots. They had alot of questions she had no answer to so they scanned the chip to get information.

Editor's note: Some people commented on the first BORU that OOP's ex was a police officer. However, I can't find anything in OOP's posts or comments that confirms this, nor has she said anything about it. (Nothing shows up when checking deleted comments either.) It's definitely possible, but I just wanted to address it here since it was brought up so often.

As a parent, seeing your baby suffer from the discomfort and irritation of diaper rash can be heartbreaking. You want to do everything you can to soothe your little one's sensitive skin and help them feel better fast. Some sources suggest that salt water baths or compresses may be a natural remedy for treating diaper rash. But is this really an effective solution? Let's take a closer look at what the evidence shows about using salt water for diaper rash treatment.

What Causes Diaper Rash?

Before we dive into whether salt water can help, it's important to understand what causes diaper rash in the first place. Diaper rash is a common skin irritation that affects many babies and toddlers who wear diapers. The main culprits behind diaper rash include:

• Prolonged exposure to wet or soiled diapers
• Chafing or rubbing from tight-fitting diapers
• Sensitive skin
• Introduction of new foods
• Bacterial or yeast infections
• Antibiotics or other medications that change stool composition

When urine and stool are pressed against delicate baby skin for too long, it can break down the protective barrier and lead to redness, inflammation, and rash. Yeast diaper rash caused by an overgrowth of Candida is especially common in the warm, moist environment of a diaper. Keeping the diaper area clean and dry through frequent diaper changing is one of the best ways to both treat and prevent diaper rash.

Does Salt Water Soothe Diaper Rash?

You may have heard that soaking your baby's bottom in salt water can help relieve the symptoms of diaper rash. The idea is that salt has natural antiseptic and healing properties. Some sources specifically recommend using Epsom salt, also known as magnesium sulfate, in bath water a few times per week.
However, it's important to note that most pediatricians and dermatologists do not recommend using salt water as a diaper rash treatment. Here's why:

• A baby's skin has a delicate pH balance that can easily be disrupted. The alkalinity and antibacterial properties of salt water may actually irritate the skin further.
• Newborns and infants have exceptionally fragile skin that is more permeable than adult skin. Soaking in salt water, especially for an extended period, may cause tiny abrasions or dry out the skin.
• Repeatedly exposing the diaper area to water, even if it contains salt, can be counterproductive. Excess moisture is more likely to aggravate diaper rash.

While a very mild saline solution is sometimes used to clean wounds, the American Academy of Pediatrics advises against using salt water on a baby's skin, especially in the diaper region^\1]). Overly concentrated salt water can disrupt the skin's natural moisture barrier. It's far better to use plain water or gentle, fragrance-free cleansers specifically designed for sensitive baby skin care.

What Are the Best Treatments for Diaper Rash?

If salt water isn't the answer for soothing diaper rash, what should you use instead? The most effective diaper rash treatment involves a combination of preventive measures and gentle, protective skincare:

Keep the Diaper Area Clean and Dry

The #1 rule of good diaper hygiene is to change wet or soiled diapers as soon as possible. Allowing a baby to sit in a dirty diaper for too long is guaranteed to increase their risk of developing a rash. Aim to change diapers every 2-3 hours during the day, right before or after every feeding, and whenever you notice they feel full.
When cleaning the diaper area, use plain warm water or gentle baby wipes. Avoid wipes that contain alcohol or fragrance. Pat the skin dry, being sure to get into all the creases, rather than rubbing.

Apply a Barrier Cream or Ointment

After every diaper change, slather on a thick layer of protective ointment or cream to soothe the skin and prevent further irritation. Look for products with ingredients like:

• Zinc oxide: A powerful skin protectant that sits on top of the skin and blocks moisture. Many diaper rash creams contain up to 40% zinc oxide.
• Petroleum jelly: This occlusive ointment creates a waterproof barrier and helps heal chapped, irritated skin. Good old Vaseline is an inexpensive, effective choice.
• Dimethicone: A silicone-based polymer that protects and moisturizes. It's a common ingredient in many diaper creams.

For stubborn rashes, your baby's doctor may recommend an antifungal cream to combat yeast or a mild hydrocortisone ointment to reduce inflammation. Always consult your pediatrician before using any medicated products on your baby's bottom.

Let the Skin Breathe

Whenever possible, give your baby's bum some bare air time to help the skin dry out and heal. Lay down a towel or waterproof pad and let your little one enjoy a diaper-free break for a few minutes several times a day. When you do need to put on a diaper, make sure it's not too tight. You should be able to comfortably slide a finger between the diaper and your baby's belly.

Consider Natural Remedies (But Skip the Salt Water)

While salt water isn't recommended, there are some other natural ingredients that may help calm diaper rash when used in moderation:

• Breast milk: The antibodies in breast milk can help fight off bacteria and promote healing. Gently pat a few drops onto the rash and let air dry.
• Coconut oil: This natural moisturizer has antimicrobial properties and can soothe inflamed skin. Use a small amount like you would diaper cream.
• Colloidal oatmeal: Finely ground oats can be sprinkled into a lukewarm bath to relieve itchy, irritated skin all over.
• Baking soda: Adding 2 tablespoons of baking soda to a basin of warm water can help neutralize the acidity of urine and soothe raw skin. Soak your baby's bottom for 5-10 minutes.

As with any natural remedies for diaper rash, check with your pediatrician first, especially if your baby has sensitive skin or allergies. Stop using anything that seems to make the rash worse.

When to See a Doctor for Diaper Rash

Most cases of diaper rash clear up within a few days with at-home measures. However, it's time to call the doctor if you notice:

• Blisters, pus-filled bumps, or open sores
• Fever along with a rash
• A rash that extends beyond the diaper area
• Persistent rash that doesn't improve after a few days of home treatment
• Bleeding or oozing skin
• Signs of pain, such as excessive crying or trouble sleeping

Your baby's doctor can determine if the rash is caused by an infection, such as a yeast diaper rash or bacterial diaper rash, and prescribe an appropriate treatment. They can also recommend the best diaper cream for your baby's particular needs.

The Bottom Line

While some sources may tout salt water as a cure for diaper rash, the evidence doesn't support this home remedy. In fact, soaking your baby's bottom in salt water may actually make the rash worse by drying out and irritating the skin.
The most effective ways to soothe diaper rash and keep your baby's bum healthy include:

• Frequent diaper changes to minimize moisture and irritants against the skin
• Gentle cleansing with water or mild, fragrance-free baby wipes
• Applying a thick barrier ointment or cream containing zinc oxide or petroleum jelly at every diaper change
• Allowing the skin to air out as much as possible
• Using hypoallergenic, breathable diapers that aren't too tight
• Seeing your pediatrician if the rash is severe or doesn't improve with at-home care

Remember, every baby's skin is unique. What works for one infant may not be the best solution for another. Trust your instincts, keep a close eye on your baby's skin, and don't hesitate to contact your pediatrician with any questions or concerns about diaper rash treatment. With a little TLC and a lot of patience, you can help your baby's bottom feel better soon!

References

1. American Academy of Pediatrics. (2021). Diaper Rash. Healthy Children. https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Diaper-Rash.aspx

Read more: https://miraridoctor.com/does-salt-water-help-diaper-rash/

Apr 24, 2023
My Story: Vasectomy, Vasectomy Reversal, and The Ongoing Recovery
This is going to be a long and detailed post made with the goal of providing as much information as possible for the purpose of helping others in their struggle against PVPS and getting on a road to recovery, with a focus for those contemplating reversal.
Background:
I am a 28 year old male, but was 27 at the time of the operation. Contemplated vasectomy since age 25 and went through two consultations.
I have always been active with unique outdoor hobbies, which will have played into my decision making process to reverse. I live in the southeast, and work an active white-collar job.
Vasectomy:
I had the procedure in June 2022. My anxiety was through the roof the morning of and waiting on the chaitable, despite taking the prescribed Percocet 1 hour before. The procedure itself was much better than I expected. The pinch/sting of the numbing agent was rough, but after that the whole thing lasted 10 minutes. Just a feeling of discomforting sensations but nothing remotely painful.
I went home confident and had an easy 3-5 days. Only needed the prescribed narcotic to sleep the first two nights, and otherwise it was icing and relaxing. On day 8, the first ejaculation was uneventful. On day 10, however, the second ejaculation resulted in pain going up my spermatic cord and into my abdomen on the right side. It wasn’t debilitating but it was concerning. I iced and went to sleep thinking I just needed more time.
Woke up and went to work and the pain began to spread into my testicles but majority on the right side. By lunch I couldn’t take it anymore and drove myself to the ER. After an ultrasound they said I had epididymitis on the right side with hydrocele and trace varicocele. I was given a steroid shot for immediate relief and sent home with antibiotics and a course of meloxicam (prescription anti-inflammatory).
My Urologist saw me two weeks later saying epididymitis is normal post-vasectomy, and that it may take 2-3 months to fully heal, and that he wouldn’t be concerned until that point. This was the beginning of my conservative treatment attempts.
I was prescribed Celecoxib, another prescription anti-inflammatory to take twice daily, morning and night. It seemed to help at the beginning, but my recovery and pain levels plateaued. 3 months post-vasectomy I returned to my urologist, and we started 50mg of amitriptyline along with 200mg Celecoxib now once a day. The nerve-blocking effect of the tricyclic did reduce my constant pain to a much more manageable level, one where it was not on my mind 24/7, but that was only half the story.
Characterization of my Pain and Discomfort:
I would describe my PVPS as twofold: acute nerve pain resulting from inflammation, and the congestion discomfort to a much lesser extent.
The first was what most people would describe as nerve pain resulting from inflammation, and that was localized to the vasectomy site. I could feel that it was much larger (inflamed) on the right side than on the left. This pain was more sharp and acute and would maintain a 1-2 out of 10 all the time, and progress to a 3-4 out of ten with physical activity. What made this the worst, however, is my primary form of recreation is called caving, where I explore caves often by rappelling and climbing ropes deep underground. To do this we wear a very tight, sewn seat harness that has a strap which runs over your hip bone, down your spermatic cord, to the side of your inguinal canal, and around your leg. Doing easy and minimal cave trips say on the weekend greatly exacerbated my pain levels throughout the work week. Ultimately, I deemed this unacceptable and had to have it fixed one way or another.
The second is the classic congestion below the vasectomy site in the epididymis. While I am thankful every day that I had no pain associated with sex or masterbation and ejaculation, for a few hours afterwards there would be a slight sensation of pressure and discomfort, but it did not seem to have any impact on the acute pain at the vasectomy site.
The latter levels of discomfort I could’ve lived with, and even the former levels of “nerve” pain near the vasectomy site became manageable after a few weeks of inactivity, but at what cost: giving up the activity I love, living a less active life, being on antidepressants/nerve blockers indefinitely? What if it got worse down the road? So, I made the decision to seek invasive treatment, sooner rather than later.
Reversal Consultation:
Both my girlfriend and I had done extensive research and were of the opinion that if I was going to do anything, it should be a reversal first: a restorative treatment. Shall it fail, then there were other options to pursue.
Having discovered my insurance would only allow $1200 towards a vasovasostomy, in-network or out-of-network, it became clear it was going to cost between $5-10K no matter where I went, so I sought out the best I could find and that was ICVR. I was encouraged by the fact that their website had a wealth of information on PVPS. I contacted them and had a consultation scheduled with Dr. Marks that week.
The consultation lasted almost an hour, and it was basically a therapy session. He went to great lengths to understand my life and the nature of my problem/pain: a truly patient-centered approach.
He came to the conclusion that he thought I had a sperm granuloma as the primary cause of my pain, with the resulting inflammation being exacerbated through my physical activity as well as ejaculation. He said a reversal would involve not only removing the granuloma, but also relieving any back-pressure making the problem worse.
Personal Decision Making Process:
It was obvious to me at this point that a vasectomy places the male reproductive anatomy in an unnatural configuration which can result in problems. Congestion, inflammation, granulomas, nerve-damage, etc.
I could’ve just had the granuloma excised, or tried to wait it out, but by doing the reversal, not only would I be eliminating what Dr. Marks thought was the primary cause of my pain, but I would hopefully be eliminating the possibility of future issues.
In my mind, the best course of action seemed to be remove the problem as soon as possible and correct what caused the problem in the first place. Yes, there was a risk of making it worse, but doing nothing wasn’t making it any better.
This was October 2022, and that week I had a flight booked, hotel reserved, and was scheduled for a morning procedure with Dr. Marks the Monday after Thanksgiving.
Vasectomy Reversal:
It was a phenomenal experience. Dr. Marks and his staff, their facility, the whole process was top-notch. You can read all about it on their website, but it’s true: I walked in that morning, was given a Xanax to relax, was walked back to the operating room and the last thing I remember is the first pulse of sedative. Woke up 3 hours later thinking I was still being prepped for surgery when in reality the incision on my scrotum was being closed and bandaged and it was all done.
Dr. Marks walked me out to the car, called me that night, came by the hotel the next day, and the entire week was a pain-free process of convalescing. On day three, with all the anesthetics having worn off, the granuloma pain was completely gone.
He indeed found one big granuloma at the vasectomy site on the right side, along with metal clamps and cauterization. I knew my Urologist used the traditional method with a scalpel, but I did not know he used clamps. There’s no way to know if my outcome would’ve been different had another method been used such as the no-scalpel.
For those of you seeking reversals for pain as opposed to fertility, fear not! ICVR has transportation arrangements if you travel to them solo. That being said, my Dad accompanied me on this trip which was really great. Despite my girlfriend and I being very serious and looking forward to hopefully a child-free marriage down the road, she is still in school and while she has been very supportive along this journey, I didn’t want to burden her with this process. She was there for me at the vasectomy, the ER, and during all the subsequent struggles.
Two Week Recovery Notes:
General discomfort from the surgery, but that’s all it was - no pain.
The first ejaculation was incredible. It’s an objective lie that orgasm doesn’t change with a vasectomy. The vas deferens and subsequent transport of sperm are involved real time in the process of ejaculation. For the sake of TMI, I won’t go into the details, but things felt how they used to feel.
I was icing at least three times a day as recommended to minimize any residual inflammation. Because of the granuloma, Dr. Marks’ protocol is a 14 day steroid taper, followed by a 7 day meloxicam course, and then a daily Celecoxib dose to be continued until semen analysis results are stable.
One Month Recovery Notes:
Original acute pain still completely gone. I was still being cautious at this point, icing morning and night, with very light physical activity, always icing before and after. This was almost entirely precautionary, as activity no longer put me in pain or exacerbated my pain.
Three Month Recovery Notes
As I reduced icing to once a day or less and began normal activities again, it became evident that there would be some lingering inflammation and discomfort from the reversal surgery itself.
I had a lot of cutting and rearranging down there within a 5.5 month period, so this was to be expected. No granuloma pain, no congestion discomfort, but just some odd sensations in the groin and spermatic cord. I suppose it is part of the healing process, and the good news was it was continuously improving.
Present Day Update (4.5 Months):
I can confidently say the reversal was the right decision for me. The granuloma pain is gone, the epididymal congestion and discomfort is gone, sex/masterbation/ejaculation is how it was before, and most importantly I am in my caving harness again doing what I love, albeit with a very expensive cup for protection until I’m 100% again.
At times over these first few months, it definitely felt like the recovery was 2 steps forward and 1 step back, especially when I’d feel some discomfort and the anxiety would creep in, but I keep moving in the right direction. I still have some odd sensations and discomfort in my right groin at times, but it is very minimal and nothing like before. My mind is no longer distracted by this 24/7.
The most pertinent observation I have now is that my scrotum/cremasteric muscle seems to be very active. Always moving up and down, and this seems to be connected to general tightness or tension in my groin, leg, and butt muscles. The more I stretch, do yoga, that sort of thing the more it improves. I am considering starting pelvic floor therapy for this as well.
Closing Comments and Thoughts:
Vasectomy is a fundamentally flawed procedure. That’s not to say it isn’t right for someone, but they are objectively risking PVPS by placing their reproductive system in an unnatural configuration, and in my opinion, that is not worth the risk. It is also why I so quickly and confidently chose reversal as the first treatment.
All in all, I would rate the severity of my PVPS as a 2 out of 10. Reading the stories of others and what they have gone through horrifies and saddens me and makes me feel lucky that I could still do my job and function day to day.
I hope my story can provide hope and useful information to others. I will answer any general questions I can about the reversal process, specifically with ICVR. If you have any personal questions feel free to message me.
Disclaimer: any and all comments should not be taken as medical advice and solely reflect personal experience freely shared for the benefit of others. All medical decisions made should be at the advice and counsel of licensed providers.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/
I think what made me confident in the decision to reverse was it was very evident that my condition had plateaued and would either stay the same with time, or worsen. I had zero reason to believe it would ever get better, and it was actually worsening in the six weeks or so before reversal.
Based off my research, I have to disagree that it’s 50/50 for improved pain or worsened pain levels. Vast majority of unsuccessful reversal stories I’ve read had no long-term effect on pain levels, and that seemed to be because they did not fix the root cause of the pain, but not because they caused new pain. For example: someone with debilitating, chronic, congestive epididymitis for years has a reversal, and the reversal doesn’t help because the condition had become so entrenched - nothing about the reversal itself caused new pain but rather the existing pain simply worsened on its own. If I had to put numbers on it, I would say it’s 50% no change, 10% worse, and 40% better. The cases where a reversal specifically worsens the existing pain in the same way seem to be the minority. As far as I know there is no postvasectomyreversalpain subreddit, but that’s not to say it doesn’t happen for many sufferers. It could very well be the case for me in 6-12 months, but I sure hope not.
As far as preventing pregnancy, my approach is twofold. Proactively, I don’t date not to mention have sex with women who want children. Preventatively, I’ve always been strict about contraception. Currently my partner uses the permanent implant which is the most effective form on the planet. Prior to that when she used oral BC or the “mini pill” we combined that with condoms. If she decided to go back to that, which may be the case because the Nexplanon is not without side effects, we would reintroduce condoms as well. I could never rely on withdrawal but I know many do and do so successfully.
If you haven’t gotten a vasectomy, don’t, and here’s some food for thought: even though the many forms of contraception for females have negative side effects, they can always be stopped. You can’t stop a vasectomy. As the male partner, all you need to do is be accommodate, flexible, and have your condoms ready when needed. It’s better than lifelong pain.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhm9bga/
I had clamps AND cauterization, although the latter was minimal and only on the ends - I’ve heard horror stories of excessive cauterization and that leading to nerve damage.
I think it’s hard to pin too much of the blame on the technique because my pain was unilateral. Why did the left side never become problematic? While I wholeheartedly agree in retrospect that putting metal inside your balls is insanity, there are plenty of medical devices of different materials used by people and they’re typically non-reactive like titanium. It’s all about the intended use and purpose, but I digress.
If anything should scare men away from a vasectomy, it’s the body modification and what that can cause: if it ain’t broke, don’t fix it.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhmgiti/
I hope you find immediate relief, but be prepared for a recovery process that involves time. According to Dr. Marks, one should set their expectations according to this: however long you dealt with PVPS is about how long it can take you to fully recover from PVPS, starting from the point of reversal. I am 4.5 months out after dealing with pain for 5.5 months, and feel about 80-90% normal, so I have found this to be true. Another reason why I now advocate for reversing sooner rather than later, IF it is determined by you and your medical providers that a reversal is right for your situation.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhmgztl/

"Epididmitis is normal post vasectomy.." Bet that wasn't covered in the pre-op information was it?

It’s laughable. My Urologist even said, “my brother got epididymitis after his vasectomy, but I didn’t perform it”. I genuinely believe that he believes it’s a good idea, otherwise why would he allow his own brother to do it?
I actually don’t blame my Urologist at all and simply blame the medical system. He was nothing but helpful and understanding the whole time, and acknowledged PVPS exists, albeit after the fact and said it was “rare”.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhoit9h/
And just to answer your question a little better: I think the ultrasound and any other imaging and analysis is very useful for determining whether a reversal or other treatments may help you, as they are things to bring to a consultation with a reversal surgeon, but they’re not going to be of much assistance with insurance. They’ll either cover it or not, and only to a certain amount. It’s very black and white.
I’ve been very thorough with my documentation to date, and yes, I tried to work with insurance for additional reimbursement due to this procedure being for the “treatment of pain” and even having an official “post operative pain” diagnosis from Dr. Marks, but the people you talk to on the phone don’t care about any of that and are just looking through billing codes.
In order to pursue further reimbursement, I would most likely have to hire a lawyer and not only prove to a judge that a vasectomy reversal is the “standard of care” for PVPS, which insurance will deny even exists, but also go through extensive document discovery to show there is internal precedent for insurance paying beyond allowable amounts for pain treatment.
The cost of doing all that would exceed what I paid. Maybe for $100K, but not $10K. That’s just life. Would rather hurt in my wallet than my balls.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhol2qp/

I really want to know your difference in orgasm. Yes, please give details :)

Haha, alright I’ll do my best…
Separating a male orgasm into two distinct sensations: one of them being external and more concentrated on the head/shaft of the penis and having lots of pleasure and sensitivity, and the other being more internal and related to the contraction and release of semen. The former did not change with a vasectomy, but the latter very much did. Not only did that release not seem to exist, but the ejaculation itself was much weaker. Less feeling of the movement and release of fluids. This part of the orgasm returned with the reversal.
Scientifically speaking, recall from biology class the muscle movement of peristalsis, which is the rhythmic contraction of smooth muscle, most commonly used to the describe the intestines moving digested food. Well, it turns out that the vas deferens are a combination of fibrous and smooth muscle, and they too use peristalsis during ejaculation to move sperm from the testes to the prostate so it can be mixed with seminal fluid secretions and expelled. I suspect why the orgasm is so diminished is this critical, anatomical function of the vas deferens undergoing peristalsis is severed by a vasectomy.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhqy36d/

My pet theory is that some guys are not suited to vasectomy.

I wholeheartedly agree that some people simply aren’t compatible with it. There has been research done that younger guys, let’s just say 40 or under, but especially under 30, have higher testosterone and sperm production that isn’t reabsorbed by the body. Knowing this, how could one expect anything other than congestive epididymitis. We’re basically rolling the dice hoping that the system handles and compensates for the newly introduced back pressure. And not only that, but since the pressure doesn’t equalize it also helps form sperm granulomas at the vasectomy site.
Why this is only on one side in cases like ours I do not know, and it’s all the more puzzling with an uneventful procedure. I don’t remember having those levels of sensitivity even only three weeks out. Definitely keep us updated as the first three months in my experience were critical to determine if it would improve or plateau. Luckily for me any pain with orgasm leveled off quickly in about a month, and hopefully that is the same for you.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/jhwcp1e/
It absolutely sucks. I would say that the minimal amounts of discomfort I still experience are up higher as well, but still only on the right side. It also can spread a little into the groin and thigh, but very minimally. I tell you this because it might give you more reason to be optimistic because if we’re having similar sensations after reversal that are part of the healing process, and mine is consistently improving, then yours may too in time.
Question, did you happen to notice any change in height to your testicles after your reversal? I can’t be entirely sure, because I never paid attention to it for the first 27 years of my life, but after my reversal the right testicle hangs significantly higher than the left. I know Dr. Marks removed 2cm on the right side and only 1cm on the left, but the difference seems more drastic than that. I also have a pretty active scrotum/cremasteric reflex that is always moving around, but it seems the more I relax and stretch the better this gets, and less discomfort.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/ji3nneh/
I’m actually thinking that any lingering discomfort I may have might be related to a potential variocele from the vasectomy or vasectomy reversal, with all the cutting that went on in a span of 5.5 months. Perhaps because the pain you’ve experienced is up so high that it is the veins in the spermatic cord itself?
I’ve noticed the veins in the spermatic cord at times seem larger on my right side than on my left. Currently been researching diet and exercise/stretching routines that I can do to improve blood flow in that region and help the area heal.
From my research I’ve seen some places say that once varicoceles form they don’t go away on their own, but I simply refuse to believe that and am of the opinion that is the medical establishment pushing more surgery for profit.
https://www.reddit.com/postvasectomypain/comments/12y450i/my_story_vasectomy_vasectomy_reversal_and_the/ji3oohq/
Metadata:
ID: 0d158968
Name: TheCaveFox
Vasectomy Date: 2022-06
Birth Year: 1995
Source: reddit
Posted: 2023-04-24
Location: USA
Storycodes: PSX,LTP,OTR,SGR,DC
Reversal Date: 2022-10
Months: 10
Resolved: Yes

May 24,2024
I 24F recently became aware of the fact that I got chlamydia. if you’re reading this reddit my assumption is you’re probably currently going through the same or know someone who is. so i’m choosing to share my personal experience as i’m sure this could bring someone out there any level of comfort or help them if they happen to share the same anxieties or symptoms i’ve been experiencing.
it began a month or two ago. my body had been experiencing chronic yeast infections before my diagnosis. so to me this just so happened to be a very aggressive yeast infection, or so I thought. my discharge was very runny, like a splash of water, almost with little specks of white discharge and maybe some body cramps. (my period was and has always been irregular so this was common for me). I had this point experienced what I would consider to be little to no symptoms indicating anything even close to chlamydia, I now know that chlamydia can be asymptomatic. I at that point I had gotten tested for a full STD screening at least twice in a 60 day period and everything had come back negative. It wasn’t until I want to say 2 months and a half to three months after my initial “symptoms” of what I was suspecting was an aggressive yeast infection that my OB/GYN had ran another STI/STD screening, and it came about that I actually had chlamydia.
I wasn’t exactly jumping up in the air at the news. However, I understood that I had chosen to have premarital sex without protection. And so, this was the price to pay in accordance of a “sneaky link” aka allowing my body to be used by someone who i’m positive has had sex with other partners and didn’t share the slightest interest in caring about me or my well being. you live you learn.
I guess it’s also important to state that at the point of the sexual intercourse I was still experiencing the symptoms I had with this “yeast infection” this may or may not have had something to do with perhaps, accelerating or assisting chlamydia happening to me. the timeline is iffy with all the negative tests results received prior (I’m not sure at that point if the negative results were indicative of no chlamydia infection, or just false negatives)
as far as my prescription, I was prescribed a weeks worth of doxycycline 100 mg and I was to take one pill every 12 hours for a total of 14 pills. I believe it was either on day three or four that I took a dose of medication on an empty stomach and threw it up. This off set my medication by 12 hours. however, I was prompt into calling my doctors office and they quickly prescribed just one extra capsule. so I waited until it was time to take my next dosage 12 hours later, and continued so on and so forth.
It wasn’t until after I finished my full week of doxycycline medication that I began to feel symptoms. or what i would consider serious ones anyway (serious enough to have concerned me). I’m now a full week out after having finished my full course of medication. i’m experiencing severe soreness and chronic inflammation in my pelvic area both internally and externally with focus in the groin. I realized this after going to the gym and attempting to do squats on the smith machine when a sharp pain shot down my uterus and hasn’t gone since. this was 4 days ago. (3 days post meds) after some research it’s come to mind i could have contracted PID pelvis inflammatory disease. I’ve called my doctors office who stated they can’t test again until 3 months out and instead prescribed 2 fluconazole 150mg tablets to take 48 hours apart for a potential yeast infection as doxycycline can lead to yeast infection.
I, like yourself have scoured reddit to see people who have had to take 2/3 rounds of doxycycline to no avail and have had issues where the infection spread to their fallopian tubes and only became aware of it after a visit to the ER.
i’ll be updating this post with any and all future symptoms/medications prescribed whether they’ve helped or not in effort to share my experience with others who may be going through the same or have any questions in regards to symptoms/ anxieties of having to tell your partner(s) because i had to go through that as well. feel free to leave a comment or share your experience & if your symptoms went away or what helped you.
Goodluck & thanks for your time.
EDIT being that my primary OBGYN was refusing to see me until 3 months out post-chlamydia diagnosis, I took it upon myself to visit a local planned parenthood for answers where the nurse practitioner there took another urine test for chlamydia to be sure the medication i’d taken had worked.(pending results currently) as well as took a swab and looked under the microscope.
at this point in time i’d been informed that i was now going through a case of bacterial vaginosis likely caused by the chlamydia. they followed to prescribe another fluconazole pill to take the day of the appointment along with 14 metronidazole, 500 mg tablets to begin on the next day. which i was to take over the course of the week twice a day morning and evening. ending it with another fluconazole 24 hours after my final dosage of metronidazole.
couple of things, my discharge has been on a constant, a lot less watery consistency, and more of that thicker jelly consistency. Also, my urine has had a brown tinge to it, after google search, it did mention about taking antibiotics and how that might be the culprit as i was worried it had something to do with my kidneys. also my bladder has felt more swelling than normal almost like a pressure when you’ve held your urine in for too long im concerned of a uti in this case as well, however i don’t know for sure. i’ll be finishing out the last days of my meds & will continue to edit this post as i am going through treatment.

I spend a lot of time researching how our nervous system works and what may contribute to the development of Visual Snow and other symptoms. Remember that there is a lot of vital information that I do not know, and may greatly benefit our understanding of this condition. Visual snow is described as an "epileptic" firing in the visual system in the brain. (tinnitus behaves very similarly but it is occurring in the auditory nerves) NMDA glutamate receptors, which are overexpressed after excitotoxic injury may well be the trigger of an increased spontaneous firing in the nerves. In turn, the brain would decode this increased firing as "visual snow". The idea is that remaining nerve endings have been damaged enough to overexpress NMDA Glutamate receptors, thus increasing their spontaneous firing.
There are various factors that contribute to the development of this condition. Everybody first had an initial trigger, and this varies from person to person. Common causes include stress, trauma, recreational and prescription drugs, Lyme, mold, heavy metals, and other toxic exposures. But what they all result in is brain injury and neuronal damage. The severity varies from person to person. The consequences of such injury doesn't just cause break in communication between healthy neurons, but a cascade of events that can lead to further neuronal degeneration and cell death. That is where visual snow comes in. Think of a broken radio or a TV where it isn't able to receive and process incoming signals so the outcome is a lot of visual/auditory noise. Our brains behave in a similar manner when there is an interference with proper neuron function and communication. Another good example is a type of neuropathic pain called "paresthesia" where you experience tingling and pricking sensations in various parts of your body. When nerves are damaged, they can't communicate properly and that miscommunication causes symptoms such as pain, tingling or numbness.
Medical researchers searching for new medications for visual snow often look to the connection between the nerve cells in the brain and the various agents that act as neurotransmitters, such as the central nervous system's primary excitatory neurotransmitter glutamate. Visual snow can be caused when damaged brain cells emit an excess of glutamate. Many treatments use ingredients that work as glutamate antagonists, or inhibitors. Communication between nerve cells in the brain is accomplished through the use of neurotransmitters. There are many compounds that act as neurotransmitters including acetylcholine, serotonin, GABA, glutamate, aspartate, epinephrine, norpinephrine and dopamine. These chemicals attach to nerve cells at specific receptors that allow for only one type of neurotransmitter to attach. Some of the neurotransmitters are excitatory; leading to increased electrical transmission between nerve cells. Others are inhibitory and reduce electrical activity. The most common excitatory neurotransmitters are glutamate and aspartate while the primary inhibitory neurotransmitter is GABA. It is necessary for excitatory and inhibitory neurotransmitters to be in balance for proper brain function to occur. Communication over synapses between neurons are controlled by glutamate. When brain cells are damaged, excessive glutamate is released. Glutamate is well known to have neurotoxic properties when excessively released or incompletely recycled. This is known as excitotoxicity and leads to neuronal death. Excess glutamate opens the sodium channel in the neuron and causes it to fire. Sodium continues to flow into the neuron causing it to continue firing. This continuous firing of the neuron results in a rapid buildup of free radicals and inflammatory compounds. These compounds attack the mitochondria, the energy producing elements in the core of the neuron cell. The mitochondria become depleted and the neuron withers and dies.
Excitotoxicity has been involved in a number of acute and/or degenerative forms of neuropathology such as epilepsy, autism, ALS, Parkinson’s, schizophrenia, migraines, restless leg syndrome, tourettes, pandas, fibromyalgia, multiple sclerosis, Huntington's, seizures, insomnia, hyperactivity, OCD, bipolar disorder and anxiety disorders (doctors use two basic ways to correct this imbalance). The first is to activate GABA receptors that will inhibit the continuous firing caused by glutamate. The second way to correct the imbalance is use antogonists to glutamate and its receptor N-methyl-d-aspartate (NMDA). These are termed glutamate or NMDA antagonists. By binding with these receptors, the antagonist medication reduces glutamate-induced continuous firing of the neuron. This explains why some drugs like clonazepam and lamictal are able to help relieve symptoms in some patients. They help reduce excitatory action in the brain temporarily., (anxiety, depression, brain fog, depersonalization, visual disturbances (including visual snow, palinopsia, blue field entoptic phenomenon, photophobia, photopsia headaches, tinnitus) are all common symptoms associated with increased excitatory activity in the brain. Excessive glutamate is the primary villain in visual snow. I strongly believe there are some genetic components that play a huge role in the development of Visual Snow and makes some individuals more susceptible to developing it. Normally, glutamate concentration is tightly controlled in the brain by various mechanisms at the synapse. There are at least 30 proteins that are membrane-bound receptor or transporter proteins at, or near, the glutamate synapse that control or modulate neuronal excitability. But in Visual Snow sufferers, my hypothesis is that we carry a faulty gene that results in dysregulation of the proteins that control and regulate glutamate excitability. They are unknown as more research will be needed.
We live in a society where we are stressed emotionally, financially, physically and exposed to a range of toxins in our environment. Combining underlying genetic susceptibility with these other factors creates all the ingredients for a perfect storm. Stress + Infectious Agents (if any) + Toxins + Genetic Susceptibility = Health Condition.
Included below is a list of things that can lead to excitotoxicity. The list includes trauma, drugs, environmental, chemicals and miscellaneous causes of brain cell damage. (Keep in mind everybody's bodies behave and react differently to various substances). -Severe Stress (Most people that are stressed out don’t realize that once the fight-or-flight response gets activated it can release things like cortisol and epinephrine into the body. Although these boost alertness, in major concentrations, the elevated levels of cortisol over an extended period of time can damage brain functioning and kill brain cells). -Free Radicals – Free radicals are highly-reactive forms of oxygen that can kill brain cells and cause brain damage. If the free radicals in your brain run rampant, your neurons will be damaged at a quicker rate than they can be repaired. This leads to brain cell death as well as cognitive decline if not corrected. (Common causes are unhealthy diet, lifestyle and toxic exposure) -Head Trauma (like concussion or contusion) MRI can detect damaged brain tissue BUT not damaged neurons. -Dehydration (severe) -Cerebal Hypoxia -Lyme disease -Narcolepsy -Sleep Apnea -Stroke -Drugs (recreational or prescription) -Amphetamine abuse -Methamphetamines -Antipsychotics -Benzodiazepine abuse -Cocaine -Esctasy -LSD -Cannabis -Tobacco -Inhalants -Nitrous Oxide -PCP -Steroids -Air Pollution -Carbon Monoxide -Heavy Metal Exposure (such as lead, copper and mercury). -Mold Exposure -Welding fumes -Formaldehyde -Solvents -Pesticides -Anesthesia -Aspartame -MSG (Monosodium Glutamate is found in most processed foods and is hidden under many various names) -Chemotherapy -Radiation -Other toxic exposures
Inside the Glutamate StormBy: Vivian Teichberg, and Luba Vikhanski "The amino acid glutamate is the major signaling chemical in nature. All invertebrates (worms, insects, and the like) use glutamate for conveying messages from nerve to muscle. In mammals, glutamate is mainly present in the central nervous system, brain, and spinal cord, where it plays the role of a neuronal messenger, or neurotransmitter. In fact, almost all brain cells use glutamate to exchange messages. Moreover, glutamate can serve as a source of energy for the brain cells when their regular energy supplier, glucose, is lacking. However, when its levels rise too high in the spaces between cells—known as extracellular spaces—glutamate turns its coat to become a toxin that kills neurons. As befits a potentially hazardous substance, glutamate is kept safely sealed within the brain cells. A healthy neuron releases glutamate only when it needs to convey a message, then immediately sucks the messenger back inside. Glutamate concentration inside the cells is 10,000 times greater than outside them. If we follow the dam analogy, that would be equivalent to holding 10,000 cubic feet of glutamate behind the dam and letting only a trickle of one cubic foot flow freely outside. A clever pumping mechanism makes sure this trickle never gets out of hand: When a neuron senses the presence of too much glutamate in the vicinity—the extracellular space—it switches on special pumps on its membrane and siphons the maverick glutamate back in. This protective pumping process works beautifully as long as glutamate levels stay within the normal range. But the levels can rise sharply if a damaged cell spills out its glutamate. In such a case, the pumps on the cellular membranes can no longer cope with the situation, and glutamate reveals its destructive powers. It doesn’t kill the neuron directly. Rather, it overly excites the cell, causing it to open its pores excessively and let in large quantities of substances that are normally allowed to enter only in limited amounts. One of these substances is sodium, which leads to cell swelling because its entry is accompanied by an inrush of water, needed to dilute the surplus sodium. The swelling squeezes the neighboring blood vessels, preventing normal blood flow and interrupting the supply of oxygen and glucose, which ultimately leads to cell death. Cell swelling, however, is reversible; the cells will shrink back once glutamate is removed from brain fluids. More dangerous than sodium is calcium, which is harmless under normal conditions but not when it rushes inside through excessively opened pores. An overload of calcium destroys the neuron’s vital structures and eventually kills it. Regardless of what killed it, the dead cell spills out its glutamate, all the vast quantities of it that were supposed to be held back by the dam. The spill overly excites more cells, and these die in turn, spilling yet more glutamate. The destructive process repeats itself over and over, engulfing brain areas until the protective pumping mechanism finally manages to stop the spread of glutamate.
"Recent research has confirmed that hypermetabolism has been primarily found in the right lingual gyrus and left cerebellar anterior lobe of the brain in individuals suffering from visual snow. The definition of hypermetabolism is described as "the physiological state of increased rate of metabolic activity and is characterized by an abnormal increase in metabolic rate." Hypermetabolism typically occurs after significant injury to the body. It serves as one of the body's strongest defence against illness and injury. This means that the brain is trying to compensate for the injured areas in the brain by increasing metabolism to meet it's high energy demands. It is trying to function to the best of it's ability under the circumstances. Normally the body can heal itself and regenerate under the right circumstances. But it is extremely difficult for the central nervous system - which includes the spinal cord and brain to be able to do so, due to it's inhibitory environment which prevents new neurons from forming. That is where stem cells come in. Stem cells are an exciting new discovery, because they can become literally any cell in the body including neurons. This is an amazing scientific breakthrough and has the potential to treat a whole host of conditions. Scientists are currently doing research and conducting trials.
Excitotoxicity can trigger your "fight or flight" response, as this is the body's primary response to illness, injury or infection. If the brain and the body remain in the sympathetic fight or flight state for too long and too often, it is degenerative; it breaks us down. If this cycle continues, then eventually the system burns out. It is this cycle that results in autonomic nervous system dysfunction. The results are disastrous, digestion is shut down, metabolism, immune function and the detoxification system is impaired, blood pressure and heart rate are increased, circulation is impaired, sleep is disrupted, memory and cognitive function may be impaired, neurotransmitters are drained, our sense of smell, taste and sound are amplified, high levels of norepinephrine are released in the brain and the adrenal glands release a variety of hormones like adrenaline and cortisol.
I believe that in order to find a treatment or cure for VS and it's accompanying symptoms, we need to address the underlying cause, reduce the excess excitatory activity in the brain, repair the damaged neurons, regain proper communication between neurons, rebalance the autonomic nervous system and prevent further cellular damage. We also need to figure out what genes, if any come into play. There is still a lot we don't know about the brain because it is such an remarkably complex organ.
FAQs., Won't lowering the levels of glutamate solve the problem? Well, not necessarily. That is just one piece of the puzzle. You have to remember that Visual Snow is a multifactorial and complex condition in which it stems from a number of different causes and influences. Based on my knowledge and the information I have gathered, I can conclude that the overstimulation of glutamate plays a huge role in VS and some other symptoms we experience. But there is still so much we don't know. That's why more research will be needed.
Why is my condition worsening over time? That is a very good question. It is because the physiology, biology and chemistry of your brain and nervous system has been altered and has become dysfunctional since the initial trigger set off a domino of effects that leads to further degradation in the body. This puts a huge strain on your body and is constantly activating your stress response system. This will wreak havoc on your entire body. The stress response system was designed to deal with brief emergencies that threaten survival. It isn't supposed to last very long because the body cannot sustain itself for very long in this state. When you remain in "fight or flight" sympathetic state for too long, it becomes degenerative and breaks our bodies down. This affects every system in the body. When you are constantly under stress, the stress response system never turns off resulting in an ongoing destructive cycle. Stress can also exacerbate all your symptoms and makes you susceptible to developing other chronic health conditions.
How is the gut related to VS?Having increased intestinal permeability is very common in this modern world because we are constantly being bombarded by toxins and stress. Our bodies weren't designed to handle such a huge burden. So we end up getting sick and become susceptible to kinds of diseases. Common causes include: -Poor diet (from excessive consumption of foods such as grains, legumes, sugars, alcohol) -Chronic stress -Toxin overload -Gut dysbiosis (It means you have a lack of beneficial bacteria in your gastrointestinal (GI) tract. They are overpowered and outnumbered by pathogens such as pathogenic bacteria, yeast, viruses, parasites). -Overuse of antibiotics., When you have increased intestinal permeability, the epithelium on the villi of the small intestine becomes inflamed and irritated, which allows metabolic, microbial and environmental toxins and undigested food particles to flood into the blood stream. This event compromises the liver, the lymphatic system, and the immune response including the endocrine system. It is often the primary cause of the following common conditions: asthma, food allergies, chronic sinusitis, eczema, urticaria, migraine, irritable bowel, fungal disorders, fibromyalgia, and inflammatory joint disorders including rheumatoid arthritis are just a few of the diseases that can originate from having poor gut health. This sets the stage for chronic systemic inflammation, oxidative stress, mitochondrial dysfunction, impaired detoxification, gastrointestinal dysfunction and immune system dysregulation. Some toxins have the ability to damage and destroy neurons, myelin sheaths, synapses and even DNA. An overload of toxins that the immune system is not able to get rid of disrupts normal brain function. This eventually initiates an autoimmune response where the immune system attacks the brain and nerve cells as it tries it’s best to eliminate the toxins. The mitochondria are the energy producing section of your cells. When they are damaged by the toxic overload in the brain cells and are not able to produce energy to fuel the cell, the cell dies. In order to stop this vicious cycle, the underlying biological mechanisms of VS needs to be understood. That is the first step that needs to be taken. Any other stressors also needs to be addressed in order to reduce the overall stress load.
It is important to know that VS is just a symptom of underlying physiological stress in the brain. Symptoms are your body's way of communicating with you, letting you know something is wrong in the body.I've come across some research indicating that microglial activation and elevated nitric oxide is involved in some neurological conditions. Basically the microglial cells are our brain's immune cells and when something triggers an inflammatory response, they activate and release harmful neurotoxic compounds (such as nitric oxide and pro-inflammatory cytokines) which results in neuronal injury/death. Microglial activation can also result in a loss of synaptic connections in different regions of the brain. It's basically an autoimmune response in the brain. The neuroinflammatory process appears to be an ongoing and chronic cycle of central nervous system dysfunction. This can deplete glutathione levels in the body. Glutathione is the body’s most important antioxidant which is capable of preventing oxidative damage caused by reactive oxygen species such as free radicals, peroxides, lipid peroxides, and heavy metals. This only further exaggerates the problem, which only leads to a cascade of increased inflammation.Nitric oxide plays a vital role in this process. Elevated nitric oxide levels reduces and impair natural killer cells which leads to a vulnerable immune system that is susceptible to a variety of systemic infections. -Phobe Zhang
RedNoise_ edited the entire thing to be more readable so thank you.

Since roughly 2013 I have been going through some pretty severe health issues. It began with my body hurting all over, mainly my hips, legs and knees. At this time I had no idea what was causing the symptoms & had basically become strictly bed ridden from 2013-2020, and even then I still preferred to stay in bed because my pain is so overwhelming some days, but due to my living situation at that time I had no other choice & had to learn to live with the pain. I will say moving around a lot more did help, but also not being in a toxic stressful situation helped me a lot as well. I've noticed stress is my major flair up symptom.
Anyways, in about 2020 I was diagnosed with Lyme Disease. It took me multiple, countless attempts to even get a doctor to do this test on me because prior to this all the doctors I saw regarding my pain would just shrug it off due to my age, I am currently 29/yo F. They also would constantly just say that I was overweight, when majority of my weight gain was due to the fact I am constantly in so much pain. Prior to this condition I was very lively, walked everywhere & just overall enjoyed life. This disease has changed me into someone completely different....
Another common reason doctors refused to do testing on me was because "You have a big chest so majority of your pain is coming from that" (my bra is literally a size 38B..... So sorry doc, but don't think that's the case either)
Anyways, after finally finding a doctor to take me seriously she began me on an antibiotic for a month. After that month, no resolve in my symptoms, so she went to Doxycycline. Sadly, my symptoms still didn't get better so she referred me to the Lyme specialist in the city 30min away from where I currently live. Sadly, due to my situation I didn't have a way to get to the specialist until mid 2023.
After seeing the specialist he put me on 2 more rounds of antibiotics with no resolve & stated if I came back with no improvements he would want to do a spinal tap to ensure the Lyme disease had not gotten to my brain. This was extremely terrifying to hear.
After this I went though a dark period in my life due to my family doctor refusing to help treat my pain. My previous Dr had me on Gabapentin, but sadly moved locations and my new doctor denied continuing to keep me on that medication even though I stared it worked well for my condition.
I currently am now on 120mg methadone, but that is not even helping the pain sadly. Shit heroin didn't even help the pain, so now I'm left feeling crippled, slowly feeling my abilities to walk drifting away & then to top that off since being on methadone I've developed new GI symptoms, as well as an increase in my neurological symptoms.
Does anyone know any other ways to help with this pain? I just want to live a normal life, do normal things & be happy, but right now that seems impossible. It makes me so upset because I don't even recall ever being bit by a tick, constantly have people telling me I am too young to be in so much pain & overall find people are highly inconsiderate of my issues due to my physical appearance. It leaves me hopeless & feeling completely alone. It's the worst having family and friends argue with me and just call me lazy, when I am really just in so much pain that even the slightest pressure on my legs, hips or spine makes me almost go into tears. Sometimes it even feels like cold water running down my leg or tingly. Occasionally I feel this in the back of my head & the left side of my chest as well, which is new and highly concerning, yet my doctor didn't seem to care about that one either.
I feel like I'm going to end up dying if I can't find some way to resolve this pain & stop the progression of my Lyme disease :( anyone have any natural ways to heal myself?

I am in recovery from my ureteroscopy on a calyceal diverticulum, and while I found some journal articles and a few stray posts on here about them, I want to paint a bigger picture about my actual experience and what I felt.
This is a very long post because I wanted to err on the side of more information so that others may feel much less alone than I have felt. I have included subheadings so you can read only what is useful to you.
To start, I am a 31-year-old female with endometriosis (I explain the implications of that in one of my subsections.). I live in New York City and was operated on by a surgeon at Smith Institute for Urology at Lenox Hill Hospital, which specializes in “complex anatomy” and kidney stones.
TL;DR Calyceal diverticula are pockets on the kidneys affecting 0.5% of the population. Stones can form and get trapped due to their narrow opening (infundibulum). As a result, their pain pattern is different and diagnosis can be delayed. To resolve the problem, you will need a surgeon to remove stones and expand the opening and/or ablate the lining of the diverticulum via ureteroscopy or percutaneous nephrolithotomy.
What is a calyceal diverticulum?
For a good scientific review of what calyceal (kay-luh-SEE-uhl) diverticula are, there is a review study from 2014 with primary author Nikhil Waingankar. In short, these are pockets within the kidneys that have much narrower entry points (“infundibula”) than a normal calyx, and they are theorized to only occur in 0.5% of the human population, with an estimated 96% of those who have them forming stones inside them.
They are often found incidentally on imaging because many people remain asymptomatic. In my case, we saw “a cyst requiring further imaging to rule out neoplasm” (cancer) when I was having my appendectomy in 2022 and had a CT scan in the ER.
They will look like cysts until you either get a radiologist who knows what to look for and sees a stone inside, or until you do a CT urogram, which is a more involved CT scan where you can see if the urinary system communicates with the “cyst.” Simple cysts and neoplasms will not show urine entering the mass; a calyceal diverticulum will, because it has an entrance.
Important stipulation in my experience: endometriosis and its surgeries
My story is complicated by the fact that I have endometriosis, which is a disease wherein cells resembling uterine cells occur outside the uterus. This is an extraordinarily painful condition that causes widespread inflammation due to the uterus-like cells’ having “menstrual periods” outside the uterus. It that can occur anywhere in the body; while most people’s disease presents primarily in the ovaries, uterus, and Fallopian tubes, the disease has been found in every organ in the body. In my case, my disease was confirmed to be extrapelvic as soon as my appendix pathology report revealed that my appendix had endometriosis on it; the cells existed beyond the typical pelvic organs.
I have already had two laparoscopies for endometriosis, and while these were immensely helpful in restoring my quality of life, every abdominal surgery comes with the risk of adhesions. Adhesions are bands of tissue that the body forms when it experiences inflammation or trauma. Endometriosis forms adhesions by itself, and surgery to remove it risks further adhesions. In 2020, when I had my radical excision surgery, my surgeon had to perform ureterolysis to cut my ureters free: whether from previous surgery in 2016 or the disease, my ureters were stuck to my uterus due to adhesions.
I share this because having endometriosis and its surgeries in my history affected my path to diagnosis and probably my pain pattern. (Endometriosis forms its own nerve endings, too!) But for the record, the kidney stones and the kidney surgery in my case were more painful than endometriosis…probably because they freaked out any remaining endometriosis.
(Sorry for no source on this endometriosis information. I am unfortunately very well-read on the disease! If you want to learn more, I recommend The Center for Endometriosis Care website and the book Beating Endo.)
What did the calyceal diverticulum feel like at first?
On a Tuesday in January 2024, I was trialing prazosin, an alpha blocker related to Flomax (tamsulosin) due to PTSD nightmares.
One day after taking this drug, I woke up with 8/10 pain muscle spasms in my “iliac crest,” which is the top edge of my pelvis, on the right side. I thought I had “slept funny” and the pain subsided after about 3 hours. I tried to roll around on a lacrosse ball, thinking it was a muscle spasm.
I took the prazosin for two more days. By that Thursday, the pain lasted more like 6 hours and did not go away; I had the muscle spasms as well as a feeling that there was “trapped gas” right at my waist, right on the side of my body. Because the pain stayed at 8/10, nothing would calm it down, and I couldn’t focus on work, I went to the ER. We did a CT scan and saw nothing different from my last CT for my appendectomy. They decided it was probably a kidney infection with strange presentation due to my endometriosis and sent me home with cefpodoxime, an antibiotic.
I finished the course of the antibiotic over 7 days and felt better.
But then the “trapped gas” feeling returned and lasted 18 hours. I went back to the ER, mostly concerned that I had failed antibiotics and the “infection” was getting worse. I made a urologist appointment while I was waiting in the ER because I suspected this might be beyond their mandate of ruling out anything life-threatening. We did another CT, and this time I really carefully read the results: inside what we had identified as a calyceal diverticulum in 2022 during my appendectomy CT scan were two kidney stones, each about 0.2mm. Because there was not much change from my last ER visit, the doctor at the ER did not think this explained how I was feeling. He did not want to send me home with antibiotics because he thought his colleagues were too cavalier with testing, but he did send for a urine culture and sent me home at least assured there was no emergency.
The culture came back, and I did test positive for E. Faecalis, which is a rarer bacteria to have, so the doctor at the ER urged me to get on Levaquin, an antibiotic, as soon as possible. (My endourologist later theorized this bacterium was an incidental finding; he thinks I just happened to be colonized with it and it was not causing symptoms. Regardless, it was not present in my culture before surgery.)
Again, I took almost the full course of the antibiotic and was feeling better and safer. I also saw a urologist, and she was skeptical it was an infection but told me to continue the course. She was pretty sure it was endometriosis-related but saw that I had seen my gynecologist, who has been treating me for 5 years, days prior who was pretty sure this was NOT consistent with what she had seen when we operated in 2020. The urologist said she felt this might be beyond her skills and referred me to one of her medical school colleagues who is a specialist in “complex anatomy” like calyceal diverticula as an endourologist professor at Lenox Hill in NYC.
But before I could see the endourologist, only one week after my last ER visit, I was in 9/10 pain for 7 hours overnight. I really did not want to go to the ER again, but I was vomiting, sweating, using the bathroom (both ways) constantly. After 7 hours not being able to get it to calm down, I went back to the ER.
The first thing they did was test me for sepsis, because I was being treated for an infection. They also did a CT scan again and then we saw it: one of the kidney stones had left the calyceal diverticulum and was stuck in the ureterovesicular junction (“UVJ”). By the time I was diagnosed, I was in 9/10 pain for 18 hours, so what we now know to be the renal colic phase lasted for 18 hours. They admitted me overnight to the hospital to observe and had me on ketorolac (Toradol) and oxycodone/acetaminophen (Percocet) every 6 hours alternating. The pain subsided the next morning.
Confirmation and surgery
Luckily, I had the endourologist appointment on the books already, and I got all of my images from the ER to bring to this doctor, letting him know I was confirmed to have passed the stone.
What he was able to do for me I will never forget: he showed me exactly why I was in enough pain for the ER each of the three weeks I went. Unlike a normal stone situation, a stone in a calyceal diverticulum has far more opportunities to get stuck. Also unlike a normal stone, you can feel the stone passing before it reaches the ureter because it has to leave via the narrow opening of the diverticulum. This means the pain can feel different and, due to its location within the kidney is more prone to being referred pain (pain you feel in a place other than where it originates). This is why I did not feel the pain in the classic place and why it felt much more like trapped gas. Furthermore, most radiologists do not have the same training as he did to identify where in the opening the stone was, which explained why they believed the stone was in the same place each time.
We wanted to take a “wait and see” approach on the second stone, but my body did not want to wait. As I was falling asleep one night in early March 2024, I felt that familiar “trapped gas” feeling, way too far right to be my intestines. This is 6/10 pain, so I could go to work for an important meeting, but I called to get an ultrasound and appointment right away. (We have since found that for my specific diverticulum, ultrasounds are not useful. I will need a CT urogram any time we want to visualize the kidney post-op.)
My doctor said that he wanted to attempt ureteroscopy before percutaneous nephrolithotomy because it is a less-invasive modality and we were worried about impacting any endometriosis. He had me sign paperwork consenting to either method, and it was a “game time” decision based on what he saw with the camera.
In the two-and-half week wait til surgery, his hypothesis gained traction: I would have days “on” with the pain and “off,” suggesting the stone was able to enter the diverticular opening and then flow back into the diverticulum. When I was in pain this time, I would also feel a lot of fatigue and brain fog that made it hard to work. This could be consistent with a kidney blockage, but it is hard to say for sure with an area so small.
The surgery, the stent, and the pain after the stent
The surgery itself went pretty well and only lasted 1.5 hours. The surgeon let me know that it was not easy to get into the diverticulum because the opening was not straight, as expected. He was, however, able to complete the surgery with only ureteroscopy. He removed a 0.2mm stone and observed that the stone was exactly the width of the opening, meaning it could absolutely flow into and out of it and get stuck for days. He widened the opening with laser to be “wider than a normal calyx” to allow for scarring, and, at my request to avoid further operations, ablated as much of the lining of the diverticulum as he could, encouraging it to close up.
While the surgery was uneventful, I am one of the unlucky ones who cannot tolerate a stent. This is probably due to my endometriosis, which leaves me in a heightened baseline of inflammation and nerve arousal, as well as the fact that, for me, the stent had to go into the diverticulum, which had been lasered and burned, in order for it to heal. I spent four hours in the recovery room while we tried to get my pain down to my goal of 7, which meant we needed to dose me, as we did in the ER, with ketorolac (Toradol) and oxycodone every 6 hours with no gaps in between.
I only had the stent in for 3 full days, and unfortunately, due to my specific circumstances, that was the worst pain I have ever been in. I was agnostic about 10/10 pain until this time, in which I felt like I was passing a stone and experiencing my worst endometriosis cramps at the same time. I was in 8-10/10 pain despite the painkiller regimen, and since we found that dilaudid does not work for me, this was good as they could do for me.
Thankfully, my surgeon listened to my experience and agreed to take the stent out as soon as was responsible: 72 hours later. The actual removal was uncomfortable but not painful beyond a “scrape” sensation in the urethra, and as soon as it was out, my husband noticed I could move as normal and was talking more like myself.
However, 1 out of 4 people will experience pain after the stent is removed, and risk factors include female anatomy, being “younger” (I am 31.) and having a stent in for less than or equal to 7 days.
The day of the removal I had some muscle spasms but was mostly so relieved that I slept all day.
34 hours after the removal, I experienced a feeling like I was passing a kidney stone. I was in 9/10 pain for 6 hours, feeling like I needed to move my bowels (which was not easy after opioids!) and having unrelenting spasms above my right iliac crest (top of pelvis). I was on ketorolac (Toradol) during this and knew what it was, but I otherwise may have gone back to the ER. I refused to take more opioids because my bowel was upset as well.
Today, I have had one episode of the iliac crest muscle spasms lasting an hour. I have found that crouching on the floor, against a wall, and/or going into “reclined butterfly pose” may help. It may just make me feel like I have more control over the situation.
I will update this post if I feel more pain in the coming days.
What’s next?
My endourologist/surgeon thinks it is very unlikely that I am “a stone-former” because the stones were only in the diverticulum and likely formed due to the urine reflux of that structure.
We will follow up in 3 weeks to see if the sensation I felt in March of the “trapped gas” recurs. If it does, only then would we do a CT urogram to see if the diverticular opening closes up to anywhere near its former width of 0.2mm.
This is unlikely because the surgeon lasered the opening very wide, “wider than a normal calyx,” to allow for scarring to take place. The ablation of the lining of the diverticulum should also take care of its tendency to collect urine.
I am not expected to have further stones or need for surgery, but he has seen cases of recurrence, so we need to manage my expectations.
Despite the extreme pain of the stent, I am content with my decision and hope that I do not have to go through this again. The one blessing in my case is, if this surgery succeeds, I should not have any further kidney stones.

I benefitted a lot from the advice on this subreddit and used a lot of it to guide my approach to M3 year; now that I've had the chance to sit the exam, I wanted to create an exam write-up in the hopes that it will be useful to others. This write-up is lengthy, as I wanted to include advice for any new M3 students about how to maximize 3rd year, as well as some Step 2-specific strategies and advice.
A little about me: I am a non-traditional student (in my 30s) at a mid-tier US MD school. Pre-clinical grades were good (honored 2nd year, 0.5% away from honoring 1st year). Honored every rotation in 3rd year. I am a peer tutor at my medical school and was actively involved in tutoring 1st and 2nd year students throughout my M3 year and dedicated.
I am a big believer in students teaching students and the idea that if we all work together, we all become better students and clinicians. In that spirit, I welcome you to ask me any questions that you have below.

Overview

In general, my advice boils down to:

1. Don't try to use EVERY resource. Choose a few high-quality resources and really know them well.
2. Doing well on Step 2 (and shelf exams, tbh) requires active learning strategies and continually trying to think about what the next step would be. Practice questions are a great way to do this, but challenge yourself to go beyond what each individual question to build a broader knowledge base. That way, you won't only know the answer to that specific question, but also to a whole host of related questions.

General studying tips for 3rd year + dedicated
I am a big believer that the most effective study strategy involves four big components:

1. A question bank (UWorld) - gives you primary exposure to the material and helps to identify where your gaps are.
2. A system for continuously reviewing content - I used Anki (I discuss this more below). You can also use other strategies (note-taking, old school flash cards), but the important thing is that your review strategy needs to be ACTIVE (i.e., not just re-reading your old notes, but actively quizzing yourself and covering up the answers) and it needs to be CONTINUOUS. I did not pause any Anki cards during 3rd year, so by the time I got to dedicated, I had been actively, continuously reviewing content for months.
3. Resource(s) for primary sources - this is where you go when you need to refresh on pathophysiology, look up treatment/diagnostic testing for a disease, or understand the symptoms. I prefer UpToDate for this broadly, and used some additional resources on specific clerkships that I will discuss below.
4. Practice exams - NBME practice shelf exams ("CMS forms") and NBME Step 2 practice exams; do them timed to practice pacing.

A note on AMBOSS vs UWorld
A lot of people I know use AMBOSS and like it. Some people want an additional bank of questions to study from. I didn't personally use AMBOSS at all during 3rd year, and only used it for Ethics and QI during dedicated (and honestly, it was only marginally useful - may have gotten me 1 or 2 extra points on the real step 2 exam, but not more than that).
I think the smartest way to approach Q-banks is to make sure you have enough time to complete and thoroughly review at least one. For me, UWorld was more than enough to prepare well for each shelf exam and step 2 (honored every rotation). I think that a lot of people who try to use both AMBOSS and UWorld never finish either Q-bank in its entirety, or don't really review the Q-bank adequately. I decided it was a better use of my time and money to review only one but really know it well.
A note on Anki
Anki is a powerful tool that can really help with your long term retention, but it is dangerous if used incorrectly. I suspect that many people who don't find Anki helpful simply don't use it effectively.
The purpose of Anki is spaced repetition. In order for this to work, you have to keep up with reviews and you can't pause cards. I also caution students I tutor to be cautious of relying solely on a premade Anki deck; I used the AnKing deck, as well as this deck and a home-brew deck at my medical school.
During M3 year, I would start each rotation with UWorld from day 1, and as I came across each concept in UWorld, I would do a search through my Anki cards and unpause all the cards that related to that topic (so, for instance, when I got a question about diverculitis, I would then unpause all the diverticulitis cards). I found that doing this ensured that the new Anki cards I was adding were reviews of concepts I had just studied (via UWorld), so I was able to both reinforce the new content via Anki and also ensure that the new Anki cards I was adding were concepts that I was actually familiar with. I recommended this approach over the one that I saw many classmates using (just unpausing all the cards tagged for a clerkship at the start of the clerkship and "raw dogging" them, as my friend put it). It's also a good way to keep your daily new cards (and thus, your reviews) at a manageable number. On a typical day in 3rd year, I added between 50-100 new cards and averaged 250-350 reviews daily. I was nearly always able to complete my reviews while I was at the hospital each day, leaving my home study time free for UWorld.
More on how to effectively use Anki
A note on staying sane and prioritizing high-yield content
As others have said, I think that the best way to do extremely well on Step 2 CK is to approach M3 as a yearlong dedicated period. Doing well on Step 2 is not just about your preparation for the Step 2 exam, but also your learning during each rotation and your preparation for your shelf exams. Even if you're not at all interested in a particular specialty, there is a lot to learn from each rotation that will be valuable to you as a future physician. Additionally, each specialty has its own way of approaching medical decision-making, and paying attention to these patterns of thought can help you to reason through questions on exams, as well as be a better communicator with physicians in each specialty when you become a resident and attending.
As you progress through 3rd year, there are also a few things that I think it's wise to keep in mind:

• Remember that you are a person first and a medical student/doctor second. I put this first because it's the most important. It's hard to learn when your basic needs aren't being met or you're so anxious, stressed, or depressed you can't remember anything. Find something that keeps you grounded and whole and sane and make that a priority. For me, it's distance running. I ran nearly every day of 3rd year and dedicated (often at 3 AM, before rounds). I finished 3 marathons during M3 and dedicated, including running the Boston Marathon 2 weeks before I took step 2. Running relieves anxiety, gives me an excuse to step away from studying, and evens out my mood. In total, I ran over 2500 miles during my M3 year. I don't think I would have done anywhere near as well in M3 without it.
• Get really, really good at preventive care. The US Preventive Services Task Force guidelines are highly tested on all shelf exams and on Step 2, and there really aren't that many of them. Before my family med rotation, I made an Anki deck of the A and B recommendations based on the most recent updates and kept those in rotation through Step 2 (about 150 cards total). If you're at the beginning of M3 year, (or really any point in M3) I would suggest doing this right now. Every time you see a patient in clinic, think about "what screening exams should this patient have". If you get in the habit of always doing this, by the time you get to the exam, those screening questions will be free points (and there are usually a bunch of them).
• Try to approach every patient encounter as though you are the sole physician responsible for that patient's care. Formulate your own plan independently of residents or attendings. Ask questions about all these things in your patient interview, and present the answers to your attending. You will learn more if you push yourself to try to think about management from the beginning of 3rd year rather than relying on plans from your residents.
• Pay attention to sensitivity and specificity of tests. This is becoming a bigger and bigger deal on NBMEs and Step 2. Knowing sensitivity and specificity can help you determine whether a given finding in a question stem is significant or not.
• Look up every imaging test and diagnostic procedure you come across, whether in clinic or on a practice exam. A good rule of thumb for whether you understand a test is "Do I know when this test is appropriate, when it is inappropriate, and could I explain it to a patient?". I had a surgery fellow pimp me on when to order an ERCP vs MRCP; this stuff is important because it prevents unnecessary testing and allows you to get the most "bang for your buck", both in terms of diagnostic accuracy and scoring points on the "next step" questions on exams.
• Pay attention to thresholds for follow-up observation vs treatment. If a patient has a AAA that's 3 cm, you do serial ultrasounds and watch it clinically; if it's 7 cm, you operate. Many, many conditions have similar thresholds, and you should look for the differences in how you manage a condition based on the thresholds. Sometimes this stuff is buried in the UWorld explanations, so when you see it, make a flash card or add it to your review.
• Know the USPSTF screening guidelines like the back of your hand. There aren't that many of them, and it's basically free points on every single shelf exam + step 2. Make a flash card deck with the most updated versions on day 1 and review it throughout 3rd year. Especially high yield on FM + IM, but they appear on every shelf.
• Think about what things a specialty "cares about" when you're rotating on that specialty.
  • OBGYN: gestational age, STI history/screening, social/fam Hx of risk factors for gyn cancers (breast, cervical, ovarian, endometrial).
  • Surgery: is the patient safe to take to surgery (comorbidities, heart failure, coagulopathies, meds, etc)? When is surgery indicated (i.e., do they have to go now, or can they wait)? Antibiotic prophylaxis (who needs it, and what antibiotics)? Post-op complications (the "5 W's", leaks, nearby structures that can be injured)? Normal post-op care/patient safety (DVT prophylaxis, catheter removal, infections, etc).
  • Peds: developmental milestones/normal development/growth curves, rashes (pediatricians love rashes), upper respiratory infections, stuff that gets treated differently in kids (ex. febrile UTI), neonatal hyperbilirubinemia (basically guaranteed to get at least one question on this on any peds exam)
  • IM: Preventive care/screening, vaccines, hypertension, diabetes, heart failure, ACS, liver failure/cirrhosis.
  • FM: IM + Peds + OBGYN, with a heavy focus on preventive screenings
  • Psych: Pay attention to timelines; think of every psych disease as a continuum (i.e., <1 mo = brief psychotic disorder, 1-6 mo = schizophreniform, 6+ = schizophrenia, schizophrenia + mood symptoms = schizophreniform). Find something that makes sense to you for the personality disorders (I personally mapped them all onto Harry Potter characters and now I will never have to re-learn them).
  • Neuro: Differentiating causes of stroke, multiple sclerosis, when to get an MRI (answer: always get an MRI in neuro), different types of dementia

Subject Review

This section is intended for those who are starting or still in the midst of M3 year. If you're already in dedicated, this section may be less useful.
For all rotations, my strategy was generally:

1. Complete the UWorld Shelf exam Q-bank with 1-2 weeks to spare
2. Make/unpause Anki cards as I worked through UWorld
3. Take timed NBME practice shelf exams regularly throughout the rotation(I sat down at the start of each rotation and planned these out every 1-2 weeks so they were evenly spaced throughout the rotation). Get through every practice exam by the end of the rotation. Doing them timed is important because it helps you to practice pacing. One 50-question exam at 90 seconds/ question = 75 minutes total. I also wrote down the diagnosis for each question so that when I reviewed the exam, I could see whether any wrong answers were a problem with making the wrong diagnosis vs knowing the next step. Doing the NBME shelf exams also gives you a good sense of what the "pet concepts" that tend to occur over and over are (for instance, SCFE vs Legg-Calve-Perthes comes up shockingly often)

Order of rotations:
I did my rotations in the order listed below and I really liked this order. I know many people advocate for finishing on Internal Medicine, but I was very glad I started with it, because I think it laid a strong foundation for everything else. As long as you have a solid strategy for reviewing the IM content continuously throughout the year, I think it's a smart choice for the first rotation, especially because basically every other shelf exam will have 5-10 IM questions on it.
Medicine
Resources: UWorld (IM shelf bank + 1/2 of Ambulatory), Case Files Internal Medicine (did ~50% of it), USPSTF A & B guidelines, NBME practice shelf exams ("CMS forms"), Emma Holliday review
Advice: If you have free time 1-2 weeks before starting IM, get through as much of Case Files as you can. It lays a good base and helps you get into the mindset of IM. Once you start the rotation, crank through UWorld. I'd suggest trying to finish the UWorld Q's with 1-2 weeks to spare at the end of the clerkship in which you can review incorrects and/or shore up any weak areas.
Raw Score: 85
Neurology
Resources: UWorld, Case Files: Neurology, NBME practice shelf exams ("CMS forms")
Advice: Case Files Neuro is a little in the weeds, but it will help a lot with some of the more off-the-wall pathologies that aren't really seen in the UWorld bank.
Raw Score: 90
Psychiatry
Resources: UWorld, Case Files: Psych, NBME practice shelf exams ("CMS forms"). A lot of people swear by First Aid for the Psychiatry Clerkship; I didn't use it (but I think Case Files accomplished much the same purpose)
Advice: Pay attention to timelines + enjoy the psychation! This is the lightest rotation for most people. Take it in the summer if at all possible and enjoy the nice weather and free time. If you can, get it somewhere in the middle of 3rd year so you can have a little break.
Raw Score: 94
Family Medicine
Resources: UWorld (FM bank + 1/2 of ambulatory bank), Case Files: Family Med, NBME practice shelf exams ("CMS forms"), USPSTF A & B guidelines, CDC vaccination schedules
Advice: Try to take FM after IM, if at all possible. DO NOT underestimate the family medicine shelf exam. It is the broadest shelf exam, and it's heavily weighted towards prevention, so plan your studying accordingly. Know the USPSTF guidelines and vaccine schedules like the back of your hand (this is at least 25-30% of the shelf exam).
Raw Score: 85
Surgery
Resources: UWorld (Surgery bank + EM bank), de Virgilio's Surgery, NBME practice shelf exams ("CMS forms") for EM and Surgery, American College of Surgeons TEAM (Trauma Evaluation and Management) course book, Emma Holliday review
Advice: The surgery shelf exam focuses heavily on the pre- and post-surgical management of surgical patients, trauma assessment (hence the EM questions/CMS forms above), and knowing the indications for surgery. You will not be asked how to do a surgery on the shelf exam, but you will be expected to know when a surgery is indicated vs when medical management should be used instead (and also what that medical management is). De Virgilio's is a great and under-utilized resource that has a fantastic question bank at the end of each chapter. I would recommend reading at least the GI, vascular, breast, endocrine, and trauma sections (and honestly, as much of it as you have time for).
Raw Score: 85
Obstetrics and Gynecology
Resources: UWorld, Case Files: OBGYN, NBME practice shelf exams ("CMS forms"), ACOG guidelines, UWise questions
Advice: OBGYN is all about timelines (at least, the OB part is). Pay attention to gestational age requirements for diagnosis of various conditions. Know the various labs that are used to diagnose Pre-eclampsia with severe features, and really pay attention to risk factors for the various obstetric complications. As one nurse midwife I worked with put it, "The biggest risk factor anything in L & D is usually a history of the same complication". I didn't really find the UWise Q-bank that useful, but if you have extra time, it's a nice source of extra practice questions, or a good way to reinforce any trouble spots.
Raw Score: 87
Pediatrics
Resources: UWorld, Case Files: Pediatrics, NBME practice shelf exams ("CMS forms"), CDC vaccination schedule, Emma Holliday review
Advice: Know the general trends of pediatric vital signs (what's normal for an adult is abnormal for most pediatric patients and vice versa), pay attention to rashes and dermatology, and review these as often as possible. It's well worth your time to do a good review of all the glycogen storage diseases, inborn errors of metabolism, lysosomal storage diseases, etc that you forgot after Step 1. For this reason, if you can do Peds as your last rotation before Step 2 it's kind of nice...then you only have to re-learn all this stuff once. This stuff is fair game for Step 2 (and I did personally get questions on it on my exam).
Raw Score: 91

Dedicated Study

I completed my first pass of UWorld during my M3 core rotations with an average of 74%. I did reset UWorld and begin a 2nd pass during dedicated, but I found that the questions repeated a lot of content that I knew well, and ultimately decided it wasn't a good use of my time. I only completed about 20% of my 2nd pass of UWorld with an average of 92%.
My main resources during dedicated were NBME practice exams (I did 8-14 timed), UWSAs, and the Free 120. I also listened to some Divine Intervention episodes on my runs and reviewed the Emma Holliday shelf exam reviews (I had previously listened to these during my M3 rotations). Of the podcasts, I found the Divine Intervention Free 120 review the most helpful, and would strongly recommend listening to those episodes after you take the Free 120. It did a lot to help me with some test taking strategies that I used on exam day.
General advice for dedicated:

• Keep on a regular sleep schedule, even on your days off. I went to bed at 10 and got up at 6 every day, because I wanted my schedule to be close to what I would need to do on test day.
• Take days off. I took at least 1/2 a day off every week. I also ran a major marathon 2 weeks before my test day, so that was a very light weekend in terms of studying.
• Keep exercising and doing things you enjoy. For me, this meant running a marathon (something I do regularly). You don't have to go as crazy as I did, but do something to get outside and stay active. It will help you keep the anxiety under control and see the sunlight every so often.
• Take practice exams regularly and spend plenty of time reviewing them. I made a google doc to keep track of incorrects and assigned each one to a category of "why I got it wrong" (i.e., "overthinking", "knowledge gap", "guessed wrong of 2", etc). This helps to identify trends. I found that I have a tendency to overthink questions, so identifying this helped me to address this weakness and gave me confidence to go with my gut instinct on the exam.
• Don't be afraid to adjust your study plan during dedicated. I started a 2nd pass of UWorld, but after about 2 weeks of dedicated, I felt like I wasn't really getting anything additional out of it and I was remembering too many of the questions from my 1st pass, so I just stopped using it. I spent that time on other resources instead (more practice exams). Take the time to really analyze which activities are actually helping your learning. Don't just do something because that's what everyone else is doing during their dedicated.
• Keep up with your review strategy. For me, this was Anki. I spent 2-4 hours every morning during dedicated doing Anki. At times, I worried that this was too much time on Anki, but part of what makes Step 2 (and all USMLE exams) challenging is the sheer breadth of content. The best way to prep for this is to keep consistent with your review strategy.
• If there's a concept you dread seeing in a question stem, STOP, do not pass Go, do not collect $20. Take a second to go to a primary source (UpToDate, a textbook) and review that content. Make some flash cards and review it regularly.
• Practice your timing. I came up with my exam day break strategy at the start of my dedicated, and every time I took a practice exam, I practiced my break strategy (at least, the first 5 blocks of my break strategy). This made it very easy for me to execute on test day because I was already used to doing 5 blocks in a row exactly this way. I took my lunch break after block 5 instead of block 4 (because I liked the psychological factor of knowing the exam was more than halfway done). Coming back for 3 more was no problem on test day.

My practice exam scores:
CCSE: 254 (my school requires this, and it was given a few days after the final shelf exam, right at the start of my dedicated period)
NBME 9 (30 days out) 269
NBME 10 (21 days out) 268
NBME 11 (18 days out) 262
NBME 12 (15 days out) 251
NBME 13 (7 days out) 264
NBME 14 (2 days out) 264
UWSA 1 (25 days out) 254
UWSA 2 (9 days out) 268
UWSA 3 (5 days out) 266
New Free 120 (3 days out) 85%
Predicted score: 265

The Day Before

Just take a break, for the love of all that is good. I went for a run, watched some old TV, read for fun, had a nice pasta dinner, and tried to go to bed early. Laid out everything I needed (lucky t-shirt, snacks, testing permit, ID, keys, etc).
Of course, I ended up tossing and turning most of the night and slept very poorly. When I woke up, I considered trying to postpone my test, but ultimately I decided I just wanted it over and done with and I wasn't willing to wait any longer. My point here is that even if you have anxiety and/or a single bad night of sleep before the exam, you can still do very well if you've done the work. As we say in the marathon world, trust your training.

The Test

Got to the testing center 45 minutes early. Made sure the last thing I did before going through security was to take a bathroom break. Brought plenty of snacks, headache medication, chocolate, and a healthy and delicious lunch (I think there's some psychological power in knowing you have a delicious lunch awaiting you).
During the exam, I took a break of at least 5 min after every block. Personally, I found the mental break was extremely helpful. On the whole, I found the exam to be quite reasonable.
Step 2 CK: 277
My last piece of advice will be that I think doing well throughout third year is the best thing you can do. If you've had a break after 3rd year or you are an IMG or someone coming from a non-traditional program, doing a thorough content review with the CMS forms before starting Step 2 specific practice exams is a good idea.
Ultimately, I think the most important things are:
1.) Choosing a FEW, QUALITY resources to review
2.) Continuing your ACTIVE, CONTINUOUS review strategy
3.) Keeping a consistent schedule with time for sleep, healthy eating, exercise, and something you find fun (ideally something other than TV).
4.) Staying off Reddit. Really, I mean it. Especially during dedicated, it's just a black hole of anxiety and angst and you should avoid it at all costs. Come back after you get your amazing scores and pay it forward to others.